Combination compositions for treatment of cancer

ABSTRACT

Provided are methods for treating cancer in a patient by administering at least one antibiotic selected from the group consisting of clofazimine, rifabutin and clarithromycin, in combination with an aryladamantane compound. In an embodiment, the aryladamantane compound is [3-(4-chlorophenyl)-adamantane-1-carboxylic acid (pyridin-4-ylmethyl)amide], or a pharmaceutically acceptable salt thereof.

RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.16/573,325, filed Sep. 17, 2019, which is a continuation of U.S. patentapplication Ser. No. 15/805,682, filed Nov. 7, 2017, now U.S. Pat. No.10,463,654, which is a continuation of U.S. patent application Ser. No.15/287,381, filed Oct. 6, 2016, now U.S. Pat. No. 9,844,540, whichclaims the benefit of and priority to U.S. provisional Application Ser.No. 62/237,925, filed Oct. 6, 2015, the entire disclosures of each ofwhich is incorporated by reference in their entirety.

BACKGROUND

Cancer is a group of diseases characterized by the uncontrolled growthand spread of abnormal cells. There are many different types of cancertreatment, including traditional therapies (such as surgery,chemotherapy, and radiation therapy), newer forms of treatment (targetedtherapy), and complementary and alternative therapies. It is becomingincreasingly evident that cancers are dependent on a number of alteredmolecular pathways and can develop diverse mechanisms of resistance totherapy with single agents. Therefore, combination regimens may providethe best hope for effective therapies with durable effects.

SUMMARY

Combination therapies for treating cancer are disclosed herein.

In an embodiment, a combination therapy of the present disclosure fortreating cancer offers the advantage of having enhanced anti-invasioneffects on cancer cells as compared with therapy that only includesadministering a single compound of the combination.

In an embodiment, a combination therapy of the present disclosure fortreating cancer offers the advantage of having enhanced anti-migrationeffects on cancer cells as compared with therapy that only includesadministering a single compound of the combination.

In an embodiment, a combination therapy of the present disclosure fortreating cancer offers the advantage of having enhanced anti-metastaticeffects on cancer cells as compared with therapy that only includesadministering a single compound of the combination.

In an embodiment, a combination therapy of the present disclosure fortreating cancer offers the advantage of having enhancedanti-proliferative effects on cancer cells as compared with therapy thatonly includes administering a single compound of the combination. In anembodiment, the enhanced anti-proliferation effects on cancer cells is aresult of one or more of the compounds ability to decrease or stop theproduction of, or overexpression of, cytokines in the tumor cells,stromal cells, or both. In an embodiment, the cytokine affected by thecompound is interleukin-6 (IL-6).

In an embodiment, each agent of the present invention alone is capableof at least one of anti-invasion effects, anti-migration effects,anti-metastatic effects, anti-proliferative effects, and apoptosis, andthe combination of two or more agents of the present inventionsynergistically inhibit cell growth and increase apoptosis.

It is contemplated that a combination therapy of the present disclosurecan provide synergistic benefits in cytotoxicity. For instance, thecytotoxicity of the combination treatment can be superior to theadditive effect of the individual treatment of the compoundsadministered alone. Additionally, or alternatively, a combinationtherapy of the present disclosure can provide acceptable cytotoxicity,but at a reduce dosage of the individual treatment of the compoundsalone. This can result in less adverse side effects during the treatmentprotocol, but with the same or better efficacy toward the cancer beingtreated.

In an embodiment, a pharmaceutical composition of the present inventioncomprises a first agent in combination with at least a second agentselected from the agents of Table 1, or an analog thereof, and apharmaceutically acceptable carrier or diluent. Potential combinationsof anticancer agents include a variety of permutations of agentsselected from Table 1 with/without standards of care (e.g.,chemotherapy, targeted agents, and immunomodulators).

The methods of the present invention include administering to a patienta first agent in combination with a second agent selected from theagents of Table 1, or an analog thereof, in an amount that is effectiveto treat the patient. In an embodiment, the method further includesadministering a third agent selected from the agents of Table 1. In anembodiment, the method further includes administering a fourth agentselected from the agents of Table 1. In an embodiment, the methodfurther includes administering a fifth agent selected from the agents ofTable 1. In an embodiment, the method further includes administering asixth agent selected from the agents of Table 1. In some embodiments,the methods of the present invention include administering to a patienttwo agents selected from the agents of Table 1, or analogs thereof, inan amount that is effective to treat the patient. In some embodiments,the methods of the present invention include administering to a patientthree agents selected from the agents of Table 1, or analogs thereof, inan amount that is effective to treat the patient. In some embodiments,the methods of the present invention include administering to a patientfour agents selected from the agents of Table 1, or analogs thereof, inan amount that is effective to treat the patient. In some embodiments,the methods of the present invention include administering to a patientfive agents selected from the agents of Table 1, or analogs thereof, inan amount that is effective to treat the patient. In some embodiments,the methods of the present invention include administering to a patientsix agents selected from the agents of Table 1, or analogs thereof, inan amount that is effective to treat the patient. In the presentdisclosure, the inventors have found that clinical combination of two ormore of the agents listed in Table 1 may act as a more potent version ofa single drug alone. In some embodiments, the desired effect(s) ofcombinations of anticancer agents listed in Table 1, including a varietyof permutations of agents selected from Table 1, is significantly higherthan the effect of each single agent administered alone. A combinationtherapy of the present disclosure might be hypothesized to interact intwo general ways: (a) one agent may reinforce the action of anotheragent, or (b) the two drugs may combine to exert effects that aredistinct from either individual compound.

In an embodiment, a method of limiting the growth and proliferation ofpancreatic cancer in a patient having or suspected of having pancreaticcancer comprises co-administrating to the patient at least two drugsfrom Table 1, the amounts of the drugs in combination, being effectivefor achieving the limiting of growth and proliferation of cancerouscells. In an embodiment, the administration is concurrent. In anembodiment, the administration is sequential.

According to aspects illustrated herein, there is disclosed acombination cancer therapy that includes administering effective amountsof two or more of rifabutin, clofazimine and clarithromycin to a patientin need of such treatment. In an embodiment, effective amounts ofrifabutin, clofazimine and clarithromycin are administered to a cancerpatient expressing higher than normal levels of IL-6 in their serum and,after an effective treatment period with rifabutin, clofazimine andclarithromycin, the serum concentration of IL-6 in the patient hasdiminished from the initial level to result in the reduction or ablationof cancer progression.

According to aspects illustrated herein, there is disclosed acombination cancer therapy that includes at least one antibioticselected from the group consisting of rifabutin, clofazimine andclarithromycin, with at least one or more of a serine proteaseinhibitor, a nucleoside analogue or a sphingosine kinase inhibitor. Inan embodiment, the serine protease inhibitor is upamostat. In anembodiment, the nucleoside analogue is brivudine. In an embodiment, thesphingosine kinase inhibitor is an aryladamantane compound.

According to aspects illustrated herein, a method for treating a patienthaving cancer includes administering at least one of clofazimine,rifabutin, or clarithromycin, in combination with at least one ofupamostat, brivudine or an aryladamantane compound to a subject in needof such treatment. In an embodiment, the method of administeringincludes administering to the patient therapeutically effective amountsof agents multiple times per day to reach therapeutic efficacy dosages.In an embodiment, the therapeutically effective amount of clarithromycinis from about 95 mg to about 1000 mg daily. In an embodiment,clarithromycin is administered orally as a solid dosage form one or moretimes per day. In an embodiment, the therapeutically effective amount ofclarithromycin is up to 1 gram daily for an adult. In an embodiment, twodoses of 500 mg clarithromycin are administered as an IV infusion, usinga solution concentration of about 2 mg/ml. 1 gram daily ofclarithromycin can be administered as an IV infusion for a period offrom two days to five days. In an embodiment, 1 gram daily ofclarithromycin can be administered as an IV infusion for a period ofthree days. In an embodiment, the therapeutically effective amount ofrifabutin is from about 45 mg to about 450 mg daily. In an embodiment,rifabutin is administered orally as a solid dosage form one or moretimes per day. In an embodiment, the therapeutically effective amount ofclofazimine is from about 10 mg to about 1000 mg daily. In anembodiment, clofazimine is administered orally as a solid dosage formone or more times per day. Brivudine can be administered as an activemetabolite, a salt, or in protected or in prodrug form. In anembodiment, a therapeutically effective amount of BVDU is up to 600mg/day. In an embodiment, the 600 mg is administered once daily as asingle oral dosage form. In an embodiment, the 600 mg is administered asa 150 mg single oral dosage form taken four times daily. In anembodiment, a therapeutically effective amount of BVDU is up to 500mg/day for an adult. In an embodiment, the 500 mg is administered oncedaily as a single oral dosage form. In an embodiment, the 500 mg isadministered as a 125 mg single oral dosage form taken four times daily.In an embodiment of the present disclosure, upamostat is administeredorally at a dose of about 0.5 mg/kg to about 1.1 mg/kg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 200 mg to 400 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 150 mg to 550 mg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 200 mg to 550 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 250 mg to 550 mg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 300 mg to 550 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 350 mg to 550 mg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 400 mg to 550 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 450 mg to 550 mg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 500 mg to 550 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 200 mg to 550 mg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 200 mg to 500 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 200 mg to 450 mg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 200 mg to 350 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 200 mg to 300 mg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 200 mg to 250 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 500 mg to 1000 mg. In anembodiment, upamostat is administered orally at a daily dose of betweenabout 750 mg to 1000 mg. In an embodiment, upamostat is administeredorally at a daily dose of between about 500 mg to 750 mg. In anembodiment, the therapeutically effective amount of aryladamantanecompound is 0.5 grams to 3.5 grams daily. In an embodiment, thearyladamantane compound is administered orally at a daily dose of 1.5grams daily. In an embodiment, the aryladamantane compound isadministered orally at a daily dose of 2.0 grams daily. In anembodiment, the aryladamantane compound is administered orally at adaily dose of 2.5 grams daily. In an embodiment, the aryladamantanecompound is administered orally at a daily dose of 3.0 grams daily.

In an embodiment, a combination of the present disclosure includes acompound of Structure (I)

or a pharmaceutically acceptable salt thereof; and a compound ofStructure (II)

or a pharmaceutically acceptable salt thereof. In an embodiment, thecombination further comprises a compound of Structure (III)

or a pharmaceutically acceptable salt thereof. In an embodiment, thecombination further includes a compound of Structure (IV)

or a pharmaceutically acceptable salt thereof.

In an embodiment, a method for treating cancer, or preventing cancerrecurrence or progression in a human in need thereof includesadministering to a human, concurrently or sequentially, atherapeutically effective amount of at least one antibiotic, and anaryladamantane compound.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows the efficacy of RHB-104 in monotherapy in four tumormodels. Shown are the minimum T/C values for all experiments. As aturning point, a minimum T/C value of 65% (upper limit for borderlineanti-tumor efficacy) was chosen.

FIGS. 2A and 2B show the anti-tumor efficacy of RHB-104 in monotherapy(PDX: PAXF 546). FIG. 2A shows the median relative tumor volumes as afunction of time; FIG. 2B shows individual relative tumor volumes on day28 (day of min. T/C value) (including LOCF values).

FIGS. 3A and 3B show the anti-tumor efficacy of RHB-104 in monotherapy(PDX: PAXF 736). FIG. 3A shows the median relative tumor volumes as afunction of time; FIG. 3B shows individual relative tumor volumes on day28 (day of min. T/C value) (including LOCF values).

FIGS. 4A and 4B show the anti-tumor efficacy of RHB-104 in monotherapy(PDX: PAXF 1872). FIG. 4A shows the median relative tumor volumes as afunction of time; FIG. 4B shows individual relative tumor volumes on day28 (day of min. T/C value) (including LOCF values).

FIGS. 5A and 5B show the anti-tumor efficacy of RHB-104 in monotherapy(PDX: PAXF 1998). FIG. 5A shows the median relative tumor volumes as afunction of time; FIG. 5B shows individual relative tumor volumes on day28 (day of min. T/C value) (including LOCF values).

FIGS. 6A-6E show the impact of treatments on body weights of mice. Shownare the group median relative body weights over time of all experiments(FIG. 6A) and group median relative body weights over time for each ofthe four different patient-derived pancreatic cancer tumor xenografts(FIGS. 6B-6E).

FIG. 7 is a bar graph showing the concentration of IL-6 in mouse serumafter administration of vehicle (negative control), dexamethasone(positive control), or RHB-104, followed by an LPS injection, to femaleC57BL/6 mice.

FIG. 8 is a bar graph showing the concentration of TNF in mouse serumafter administration of vehicle (negative control), dexamethasone(positive control), or RHB-104, followed by an LPS injection, to femaleC57BL/6 mice.

FIG. 9 is a bar graph showing the concentration of IL-10 in mouse serumafter administration of vehicle (negative control), dexamethasone(positive control), or RHB-104, followed by an LPS injection, to femaleC57BL/6 mice.

DETAILED DESCRIPTION

As used herein, the term “agent” refers to a compound having apharmacological activity or effect on a patient. The terms “agent,”“active ingredient,” “compound,” and “drug” are used interchangeablyherein.

The term “administration” or “administering” includes routes ofintroducing the compounds of the invention to a subject to perform theirintended function. Examples of routes of administration that may be usedinclude injection (subcutaneous, intravenous, parenterally,intraperitoneally, intrathecal), oral, inhalation, rectal andtransdermal. The pharmaceutical preparations may be given by formssuitable for each administration route. For example, these preparationsare administered in tablets or capsule form, by injection, and rectal bysuppositories. Oral administration is preferred. The injection can bebolus or can be continuous infusion. Depending on the route ofadministration, the compounds of the invention can be coated with ordisposed in a selected material to protect it from natural conditionswhich may detrimentally effect its ability to perform its intendedfunction. The compounds of the invention can be administered inconjunction with a pharmaceutically-acceptable carrier. Furthermore, thecompounds of the invention can also be administered in a pro-drug formwhich is converted into its active metabolite, or more active metabolitein vivo.

“Apoptosis” (programmed cell death) is a process that plays an importantrole in preventing cancer and in the treatment of cancer by using agentsthat induce apoptosis of abnormal cancer cells. In an embodiment, anagent or agents of the present invention have the ability to induceapoptosis in an individual. Several in vitro assays can be used to testthe efficacy of an agent of the present disclosure to induce apoptosisincluding, but not limited to, flow cytometry selected from one ofplasma membrane, mitochondrial, caspase, nuclear apoptosis, andmultiparametric apoptosis; microscopy selected from one of caspaseactivity, DNA fragmentation and morphology, annexin V staining, membranepotential and other mitochondrial assays; high-content analysis; andmicroplate assay such as a population-based assay for measuring caspaseactivity.

As used herein, the term “anti-invasion effects” means the ability of anagent or agents of the present invention to prevent cancer invasion orto reduce the incidence of tumor invasion in an individual. In anembodiment, an agent or agents of the present invention reduces theincidence of tumor invasion in an individual by about 1% to about 99.0%as compared to an existing drug known to have anti-invasion effects. Inan embodiment, an agent or agents of the present invention reduces theincidence of tumor invasion in an individual by about 5% to about 95.0%as compared to an existing drug known to have anti-invasion effects. Inan embodiment, an agent or agents of the present invention reduces theincidence of tumor invasion in an individual by about 10% to about 90.0%as compared to an existing drug known to have anti-invasion effects. Inan embodiment, an agent or agents of the present invention reduces theincidence of tumor invasion in an individual by about 20% to about 80.0%as compared to an existing drug known to have anti-invasion effects. Inan embodiment, an agent or agents of the present invention reduces theincidence of tumor invasion in an individual by about 30% to about 70.0%as compared to an existing drug known to have anti-invasion effects. Inan embodiment, an agent or agents of the present invention reduces theincidence of tumor invasion in an individual by about 40% to about 60.0%as compared to an existing drug known to have anti-invasion effects. Inan embodiment, an agent or agents of the present invention reduces theincidence of tumor invasion in an individual by about 50% as compared toan existing drug known to have anti-invasion effects.

As used herein, the term “anti-migration effects” means the ability ofan agent or agents of the present invention to prevent cancer cellmigration or to reduce the incidence of tumor cell migration in anindividual once tumor cells acquire the ability to penetrate thesurrounding tissues, the process of invasion is instigated as thesemoving cells pass through the basement membrane and extracellularmatrix, progressing to intravasation as they penetrate the lymphatic orvascular circulation. The metastatic cells then journey through thecirculatory system invading the vascular basement membrane andextracellular matrix in the process of extravasation. Ultimately, thesecells will attach at a new location and proliferate to produce thesecondary tumor. In an embodiment, an agent or agents of the presentinvention reduces the incidence of tumor cell migration in an individualby about 1% to about 99.0% as compared to an existing drug known to haveanti-migration effects. In an embodiment, an agent or agents of thepresent invention reduces the incidence of tumor cell migration in anindividual by about 5% to about 95.0% as compared to an existing drugknown to have anti-migration effects. In an embodiment, an agent oragents of the present invention reduces the incidence of tumor cellmigration in an individual by about 10% to about 90.0% as compared to anexisting drug known to have anti-migration effects. In an embodiment, anagent or agents of the present invention reduces the incidence of tumorcell migration in an individual by about 20% to about 80.0% as comparedto an existing drug known to have anti-migration effects. In anembodiment, an agent or agents of the present invention reduces theincidence of tumor cell migration in an individual by about 30% to about70.0% as compared to an existing drug known to have anti-migrationeffects. In an embodiment, an agent or agents of the present inventionreduces the incidence of tumor cell migration in an individual by about40% to about 60.0% as compared to an existing drug known to haveanti-migration effects. In an embodiment, an agent or agents of thepresent invention reduces the incidence of tumor cell migration in anindividual by about 50% as compared to an existing drug known to haveanti-migration effects.

As used herein, the term “anti-metastatic effects” means the ability ofan agent or agents of the present invention to prevent, or reduce theincidence of, at least one of the following steps in the metastaticprocess: (1) detachment of cancer cells from the primary site, (2)induction and invasion into new blood vessels, (3) exiting from theblood circulation, and (4) establishment of a new colony at distantsites. In an embodiment, an agent or agents of the present inventionreduces the incidence of one of the steps in the metastatic process inan individual by about 1% to about 99.0% as compared to an existing drugknown to have anti-metastatic effects. In an embodiment, an agent oragents of the present invention reduces the incidence of one of thesteps in the metastatic process in an individual by about 5% to about95.0% as compared to an existing drug known to have anti-metastaticeffects. In an embodiment, an agent or agents of the present inventionreduces the incidence of one of the steps in the metastatic process inan individual by about 10% to about 90.0% as compared to an existingdrug known to have anti-metastatic effects. In an embodiment, an agentor agents of the present invention reduces the incidence of one of thesteps in the metastatic process in an individual by about 20% to about80.0% as compared to an existing drug known to have anti-metastaticeffects. In an embodiment, an agent or agents of the present inventionreduces the incidence of one of the steps in the metastatic process inan individual by about 30% to about 70.0% as compared to an existingdrug known to have anti-metastatic effects. In an embodiment, an agentor agents of the present invention reduces the incidence of one of thesteps in the metastatic process in an individual by about 40% to about60.0% as compared to an existing drug known to have anti-metastaticeffects. In an embodiment, an agent or agents of the present inventionreduces the incidence of one of the steps in the metastatic process inan individual by about 50% as compared to an existing drug known to haveanti-metastatic effects. Several in vitro assays can be used to test theefficacy of an agent of the present disclosure to prevent or delaymetastatic progression including, but not limited to, scratch or woundhealing assays, trans-membrane migration assays (Modified Boydenchamber), gap-closure or exclusion zone assays as well as migrationassays using microfluidic devices (MFDs).

As used herein the term “neoplasm” refers to an abnormal growth of cellsor tissue and is understood to include benign, i.e., non-cancerousgrowths, and malignant, i.e., cancerous growths. The term “neoplastic”means of or related to a neoplasm. The term “anti-neoplastic agent” isunderstood to mean a substance producing an anti-neoplastic effect in atissue, system, animal, mammal, human, or other subject.

As used herein, the term “anti-proliferative effects” means the abilityof an agent or agents of the present invention to inhibit cancer cellgrowth and cell division or to reduce the incidence of cancer cellgrowth and cell division in an individual. In an embodiment, an agent ofthe present invention results in an anti-proliferative effect byaffecting cytokine production. In an embodiment, an agent or agents ofthe present invention reduces the incidence of cancer cell growth andcell division in an individual by about 1% to about 99.0% as compared toan existing drug known to have anti-proliferative effects. In anembodiment, an agent or agents of the present invention reduces theincidence of cancer cell growth and cell division in an individual byabout 5% to about 95.0% as compared to an existing drug known to haveanti-proliferative effects. In an embodiment, an agent or agents of thepresent invention reduces the incidence of cancer cell growth and celldivision in an individual by about 10% to about 90.0% as compared to anexisting drug known to have anti-proliferative effects. In anembodiment, an agent or agents of the present invention reduces theincidence of cancer cell growth and cell division in an individual byabout 20% to about 80.0% as compared to an existing drug known to haveanti-proliferative effects. In an embodiment, an agent or agents of thepresent invention reduces the incidence of cancer cell growth and celldivision in an individual by about 30% to about 70.0% as compared to anexisting drug known to have anti-proliferative effects. In anembodiment, an agent or agents of the present invention reduces theincidence of cancer cell growth and cell division in an individual byabout 40% to about 60.0% as compared to an existing drug known to haveanti-proliferative effects. In an embodiment, an agent or agents of thepresent invention reduces the incidence of cancer cell growth and celldivision in an individual by about 50% as compared to an existing drugknown to have anti-proliferative effects. Several in vitro assays can beused to test the efficacy of an agent of the present disclosure toprevent or delay cell growth and cell division including, but notlimited to, cell proliferation assays that measure DNA synthesis, cellproliferation assays that measure metabolic activity, cell proliferationassays that measure antigens associated with cell proliferation, andcell proliferation assays that measure ATP concentration.

The term “cytokine” refers to functional small peptides which underphysiological conditions control the cell-to-cell communication withinthe various body tissues. Cytokines are also called interleukins,monokines, lymphokines, chemokines and growth factors. It has beenobserved that the local tissue or circulating cytokine levels is alteredin a number of cancers, which may affect the development/advancement,treatment and prognosis. Elevated cytokine levels, for example, havebeen associated with reducing the anti-cancer activity of varioustreatments. Cytokines have also been demonstrated to exacerbate thetoxic effects of chemotherapy and affect drug metabolism. Inflammatorycytokines such as interferons and interleukins produced in the tumormicroenvironment play a role in stimulation or inhibition of diseaseprogression.

Diseases that can be treated using the compounds of the presentinvention include, but are not limited to cancers, such as canceroustumors. “Cancer” is meant to refer to any disease that is caused by orresults in inappropriately high levels of cell division, inappropriatelylow levels of apoptosis, or both. In an embodiment, the cancer is aresult of an infectious disease, such as a viral infection. In anembodiment, the cancer is a result of an infectious disease, such as abacterial or parasitic infection. In an embodiment, the cancer is causedby a gene mutation. Cancers that can be treated include, but are notlimited to, breast cancer, pancreatic cancer, kidney cancer, coloncancer, rectal cancer, ovarian cancer, stomach cancer, uterine cancer,carcinoma in situ, and leukemia.

As used herein, the term “pancreatic cancer” refers to any cancer havingits origin in pancreas cells, and includes metastatic and local forms ofpancreatic cancer. In 2012, pancreatic cancers of all types were theseventh most common cause of cancer deaths, resulting in 330,000 deathsglobally. In the United States, pancreatic cancer is the fourth mostcommon cause of deaths due to cancer. In certain embodiments, aparticular subpopulation of patients with pancreatic cancer can betreated according to combination therapies of this invention. Thecombination of agents of the invention may be utilized to enhance theefficacy and a reduction in the required amount of either agent toachieve the efficacy.

A “patient” refers to any animal, such as a primate, such as a human.Any animal can be treated using the methods and composition of thepresent invention.

As used herein, the term “a suitable period of time” refers to theperiod of time starting when a subject begins treatment for a diagnosisof cancer using a method of the present disclosure, throughout thetreatment, and up until when the subject stops treatment. In anembodiment, a suitable period of time is one (1) week. In an embodiment,a suitable period of time is between one (1) week and two (2) weeks. Inan embodiment, a suitable period of time is two (2) weeks. In anembodiment, a suitable period of time is between two (2) weeks and three(3) weeks. In an embodiment, a suitable period of time is three (3)weeks. In an embodiment, a suitable period of time is between three (3)weeks and four (4) weeks. In an embodiment, a suitable period of time isfour (4) weeks. In an embodiment, a suitable period of time is betweenfour (4) weeks and five (5) weeks. In an embodiment, a suitable periodof time is five (5) weeks. In an embodiment, a suitable period of timeis between five (5) weeks and six (6) weeks. In an embodiment, asuitable period of time is six (6) weeks. In an embodiment, a suitableperiod of time is between six (6) weeks and seven (7) weeks. In anembodiment, a suitable period of time is seven (7) weeks. In anembodiment, a suitable period of time is between seven (7) weeks andeight (8) weeks. In an embodiment, a suitable period of time is eight(8) weeks.

The term “therapeutically acceptable” refers to those compounds (orsalts, prodrugs, tautomers, zwitterionic forms, etc.) which are suitablefor use in contact with the tissues of patients without undue toxicity,irritation, and allergic response, are commensurate with a reasonablebenefit/risk ratio, and are effective for their intended use.

By “an effective amount” or “a therapeutically effective amount” ismeant the amount of a compound, alone or in combination with anothertherapeutic regimen, required to treat a patient with caner in aclinically relevant manner. This amount will achieve the goal ofreducing or eliminating the disease or disorder. A sufficient amount ofan active compound used to practice the present invention fortherapeutic treatment of conditions caused by cancer varies dependingupon the manner of administration, the age, body weight, and generalhealth of the patient. Ultimately, the prescribers will decide theappropriate amount and dosage regimen. In a combination therapy of theinvention, the effective amount of an agent may be less than theeffective amount if the agent were administered in a non-combinatorial(single-agent) therapy. Additionally, an effective amount may be anamount of an agent in a combination therapy of the invention that issafe and efficacious in the treatment of a patient having cancer overeach agent alone as determined and approved by a regulatory authority(such as the U.S. Food and Drug Administration).

By “more effective” is meant that a treatment exhibits greater efficacy,or is less toxic, safer, more convenient, or less expensive than anothertreatment with which it is being compared. Efficacy may be measured by askilled practitioner using any standard method that is appropriate for agiven indication.

The term “minimize” or “reduce,” or a derivative thereof, includes acomplete or partial inhibition of a specified biological effect (whichis apparent from the context in which the term minimize is used).

The term “modulate” refers to an increase or decrease, e.g., in theability of a cell to proliferate in response to exposure to compounds ofthe invention, e.g., the inhibition of proliferation of at least asub-population of cells in an animal such that a desired end result isachieved, e.g., a therapeutic result. In an embodiment, the modulationis an inhibition. The term “inhibition” means decrease, suppress,attenuate, diminish, arrest, or stabilize the target activity, e.g.,cell proliferation.

The term “combination therapy” means the administration of two or moreagents of the present invention to treat cancer. In an embodiment, eachof the agents targets different parts of the cancer cell's signalingpathway. In an embodiment, each of the agents targets the cancer cell'srelationship to the tissue environment. In an embodiment, one agenttargets the cancer cell's signaling pathway and one agent targets thecancer cell's relationship to the tissue environment. Suchadministration encompasses co-administration of these agents in asubstantially simultaneous manner, such as in a single capsule having afixed ratio of active ingredients (“fixed-dose”) or in multiple,separate capsules or tablets for each active ingredient. In addition,such administration also encompasses use of each type of agent in asequential manner. In either case, the treatment regimen will providebeneficial effects of the drug combination in treating the conditions ordisorders described herein. In an embodiment, a combination therapy ofthe present invention includes at least one fixed-dose combination oftwo or more agents. A fixed-dose provides the advantages of combinationtherapy while reducing the number of prescriptions and administrativecosts. In an embodiment, a combination therapy of the present disclosureuses lower concentrations of each drug due to synergistic or additiveeffects. In an embodiment, the use of lower concentrations of each drug(as compared with a monotherapy approach of the drug) leads to reducedadverse events and a higher therapeutic ratio or index.

“Concurrently” means (1) simultaneously in time, or (2) at differenttimes during the course of a common treatment schedule.

“Sequentially” refers to the administration of one active agent used inthe method followed by administration of another active agent. Afteradministration of one active agent, the next active agent can beadministered substantially immediately after the first, or the nextactive agent can be administered after an effective time period afterthe first active agent; the effective time period is the amount of timegiven for realization of maximum benefit from the administration of thefirst active agent.

The combination therapy may provide “synergy” and prove “synergistic”,i.e., the effect achieved when the active ingredients used together isgreater than the sum of the effects that results from using thecompounds separately. A synergistic effect may be attained when theactive ingredients are: (1) co-formulated and administered or deliveredsimultaneously in a combined, unit dosage formulation; (2) delivered byalternation or in parallel as separate formulations; or (3) by someother regimen. When delivered in alternation therapy, a synergisticeffect may be attained when the compounds are administered or deliveredsequentially, e.g., by different injections in separate syringes, byadministration of separate pills or capsules, or by separate infusions.In general, during alternation therapy, an effective dosage of eachactive ingredient is administered sequentially, i.e., serially, whereasin combination therapy, effective dosages of two or more activeingredients are administered together.

The agents of the present invention are expected to be particularlyuseful as part of a combination therapy with existing standard of carefor the treatment of cancer. In an embodiment, a combination therapy ofthe present disclosure includes administering at least two agents of thepresent invention and further co-administering the agents of theinvention with standard of care chemotherapeutic agents. In anembodiment, a combination therapy of the present disclosure includessurgical removal of the affected tissue, administering at least twoagents of the present invention, and further co-administering the agentsof the invention with standard of care chemotherapy or radiationtreatments. Current standard of care chemotherapeutic agents include,but are not limited to, antiangiogenic agents; cytostatic agents; andantiproliferative/antineoplastic agents and combinations thereof. Forexample, antineoplastic agents and combinations of agents used inmanaging pancreatic carcinoma include, but are not limited to,gemcitabine, gemcitabine/docetaxel/capecitabine,gemcitabine/capecitabine, gemcitabine/albumin-bound paclitaxel,5-fluorouracil (5-FU), LV5-FU/oxaliplatin/irinotecan,paclitaxel/gemcitabine, erlotinib, erlotinib/gemcitabine andcapecitabine, alone or in combination. Such agents have been shown toprolong survival in pancreatic cancer. In an embodiment at least twoagents of the present invention are further co-administered with one ormore of these standards of care chemotherapeutic agents.

In an embodiment, a combination therapy of the present disclosureincludes administering at least two agents of the present invention andfurther co-administering the agents of the invention with animmunomodulator. Immunomodulators are the active agents used inimmunotherapy, which modify the immune response of the immune system andcan comprise a diverse array of recombinant, synthetic and naturalpreparations. Examples of immunomodulators include, but are not limitedto, interleukins, cytokines, chemokines, and immunomodulatory imidedrugs.

In an embodiment, a combination therapy of the present disclosureincludes administering at least two agents of the present invention andfurther co-administering the agents of the invention with an immunecheckpoint inhibitor. Drugs or drug candidates that inhibit/block theinhibitory checkpoint molecules are known as immune checkpointinhibitors.

In an embodiment, a combination therapy of the present disclosureincludes administering at least two agents of the present invention andfurther co-administering the agents of the invention with a matrixmetalloproteinase inhibitor (MMPI). MMPIs inhibit cell migration andhave potential antiangiogenic effects. Examples of MMPIs includeexogenous MMPIs, including, but not limited to, tanomastat, prinomastat,batimastat and marimastat.

The terms “co-administering” or “co-administration” are intended toencompass simultaneous or sequential administration of therapies. Forexample, co-administration may include administering both a nucleosideanalogue of the present invention and a serine protease inhibitor in asingle composition. It may also include simultaneous administration of aplurality of such compositions. Alternatively, co-administration mayinclude administration of a plurality of such compositions at differenttimes during the same period.

The term “analog” of an agent or other chemical moiety includes, but isnot limited to, compounds that are structurally similar to the agent orare in the same general chemical class as the agent or. The analog ofthe agent retains similar chemical and/or physical property (including,for example, functionality) of the agent.

The phrase “pharmaceutically-acceptable carrier” includespharmaceutically-acceptable material, composition or vehicle, such as aliquid or solid filler, diluent, excipient, solvent or encapsulatingmaterial, involved in carrying or transporting the active or activesfrom one organ, or portion of the body, to another organ, or portion ofthe body. Each carrier is “acceptable” in the sense of being compatiblewith the other ingredients of the formulation and not injurious to thepatient. Some examples of materials which can serve aspharmaceutically-acceptable carriers include, but are not limited to:(1) sugars, such as lactose, glucose and sucrose; (2) starches, such ascorn starch and potato starch; (3) cellulose, and its derivatives, suchas sodium carboxymethyl cellulose, ethyl cellulose and celluloseacetate; (4) powdered tragacanth; (5) malt; (6) gelatin; (7) talc; (8)excipients, such as cocoa butter and suppository waxes; (9) oils, suchas peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil,corn oil and soybean oil; (10) glycols, such as propylene glycol; (11)polyols, such as glycerin, sorbitol, mannitol and polyethylene glycol;(12) esters, such as ethyl oleate and ethyl laurate; (13) agar; (14)buffering agents, such as magnesium hydroxide and aluminum hydroxide;(15) alginic acid; (16) pyrogen-free water; (17) isotonic saline; (18)Ringer's solution; (19) ethyl alcohol; (20) phosphate buffer solutions;and (21) other non-toxic compatible substances employed inpharmaceutical formulations.

As used herein, “treating a cancer”, “treating”, and “treatment”includes, but is not limited to, preventing or reducing the developmentof a cancer, reducing the symptoms of cancer, suppressing or inhibitingthe growth of an established cancer, preventing metastasis and/orinvasion of an existing cancer, promoting or inducing regression of thecancer, inhibiting or suppressing the proliferation of cancerous cells,reducing angiogenesis, killing of malignant or cancerous tumor cells, orincreasing the amount of apoptotic cancer cells. In some embodiments,the compounds of the invention are administered to a subject at risk ofdeveloping a cancer for the purpose of reducing the risk of developingthe cancer. The phrase “inhibiting the growth” or “inhibiting theproliferation” of cancer cells, refers to the slowing, interrupting,arresting, or stopping its growth and metastasis, and does notnecessarily indicate a total elimination of the neoplastic growth.

A “patient in need of treatment”, as used herein, means a patient thatis identified as being in need of treatment. For instance, a patient inneed of cancer treatment is a patient identified as having cancer orbeing at risk for developing cancer. A patient may be diagnosed as beingin need of treatment by a healthcare professional and/or by performingone or more diagnostic assays. For instance, patient in need of cancertreatment may be a patient diagnosed with cancer or being at risk ofcancer by a healthcare professional. Diagnostic assays to evaluate if apatient has a cancer or is at risk for developing cancer are known inthe art.

When the methods include administering to the patient more than oneactive agent, the agents may be administered within 7, 6, 5, 4, 3, 2 or1 days; within 24, 12, 6, 5, 4, 3, 2 or 1 hours, within 60, 50, 40, 30,20, 10, 5 or 1 minutes; or substantially simultaneously. The methods ofthe invention may include administering one or more agents to thepatient by oral, systemic, parenteral, topical, intravenous,inhalational, or intramuscular administration.

The methods of the present invention include administering to a patienta first agent in combination with a second agent selected from theagents of Table 1, or an analog thereof, in an amount that is effectiveto treat the patient. In an embodiment, the method further includesadministering a third agent selected from the agents of Table 1. In thepresent disclosure, the inventors have found that the mechanisms bywhich the agents listed in Table 1 work together in clinical combinationmay act as a more potent version of a single agent alone. A combinationtherapy of the present disclosure might be hypothesized to interact intwo general ways: (a) one agent may reinforce the action of anotheragent, or (b) the two drugs may combine to exert effects that aredistinct from either individual compound.

TABLE 1 Clofazimine Bactericidal Antibiotic Macrolide Antibiotic(anti-inflammatory) (for example, rifabutin) (for example,clarithromycin) 5′ Substituted Nucleosides Sphingosine Kinase UrokinaseInhibitors (for example, brivudine) Inhibitors (for example, (forexample, upamostat) ABC294640)

The agents of Table 1 may be administered within 7, 6, 5, 4, 3, 2 or 1days; within 24, 12, 6, 5, 4, 3, 2 or 1 hours, within 60, 50, 40, 30,20, 10, 5 or 1 minutes; or substantially simultaneously. The methods ofthe invention may include administering an agent from Table 1 to thepatient by oral, systemic, parenteral, topical, intravenous,inhalational, or intramuscular administration. In an embodiment, themethods of the invention include administering an agent from Table 1 tothe patient by oral administration.

In an embodiment, the present disclosure describes a cancer combinationtherapy including two or more agents selected from the agents ofTable 1. In an embodiment, the two or more agents are present in amountsthat, when administered together to a patient with cancer, are effectiveto treat the patient. In an embodiment, the composition consists ofactive ingredients and excipients, and the active ingredients consist oftwo or more agents selected from agents of Table 1.

Active ingredients or agents useful in the invention include thosedescribed herein in any of their pharmaceutically acceptable forms,including isomers, salts, solvates, and polymorphs thereof, as well asracemic mixtures and prodrugs.

In an embodiment, a combination therapy of the present disclosure fortreating cancer offers the advantage of having enhanced anti-invasioneffects on cancer cells as compared with therapy that only includesadministering a single compound of the combination.

In an embodiment, a combination therapy of the present disclosure fortreating cancer offers the advantage of having enhanced anti-migrationeffects on cancer cells as compared with therapy that only includesadministering a single compound of the combination.

In an embodiment, a combination therapy of the present disclosure fortreating cancer offers the advantage of having enhanced anti-metastaticeffects on cancer cells as compared with therapy that only includesadministering a single compound of the combination.

In an embodiment, a combination therapy of the present disclosure fortreating cancer offers the advantage of having enhancedanti-proliferative effects on cancer cells as compared with therapy thatonly includes administering a single compound of the combination. In anembodiment, the enhanced anti-proliferation effects on cancer cells is aresult of one or more of the compounds ability to decrease or stop theproduction of, or overexpression of, cytokines in the tumor cells,stromal cells, or both. In an embodiment, the cytokine affected by thecompound is interleukin-6 (IL-6). IL-6 has been shown to be involved inthe proliferation and differentiation of various malignant tumor cells.In addition, overexpression of both IL-6 and its receptors (IL-6R andsIL-6R) has been found in various cancers. Elevated levels of IL-6 havebeen found in culture supernatant of multidrug resistant cell lines andthe elevated IL-6 levels in the serum of cancer patient have beenassociated with poor clinical outcomes.

In an embodiment, each agent of the present invention alone is capableof at least one of anti-invasion effects, anti-migration effects,anti-metastatic effects, anti-proliferative effects, and apoptosisinduction, and the combination of two or more agents of the presentinvention synergistically inhibit cell growth and increase apoptosis.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount ofclarithromycin and a therapeutically effective amount of a serineprotease inhibitor. In an embodiment, the serine protease inhibitor isupamostat.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount ofclarithromycin and a therapeutically effective amount of a nucleosideanalogue. In an embodiment, the nucleoside analogue is brivudine.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount ofclarithromycin and a therapeutically effective amount of anaryladamantane compound that is an inhibitor of sphingosine kinase,either sphingosine kinase 1 (SK1) or sphingosine kinases 2 (SK2). In anembodiment, the aryladamantane compound is[3-(4-chlorophenyl)-adamantane-1-carboxylic acid(pyridin-4-ylmethyl)amide] also known as “ABC294640”. In an embodiment,the aryladamantane compound is ABC294735.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount ofclarithromycin; a therapeutically effective amount of a serine proteaseinhibitor; and a therapeutically effective amount of a nucleosideanalogue. In an embodiment, the serine protease inhibitor is upamostat.In an embodiment, the nucleoside analogue is brivudine.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount ofclarithromycin; a therapeutically effective amount of a serine proteaseinhibitor; and a therapeutically effective amount of an aryladamantanecompound that is an inhibitor of sphingosine kinase, either sphingosinekinase 1 (SK1) or sphingosine kinases 2 (SK2). In an embodiment, theserine protease inhibitor is upamostat. In an embodiment, thearyladamantane compound is [3-(4-chlorophenyl)-adamantane-1-carboxylicacid (pyridin-4-ylmethyl)amide] also known as “ABC294640”. In anembodiment, the aryladamantane compound is ABC294735.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount ofclarithromycin; a therapeutically effective amount of a serine proteaseinhibitor; a therapeutically effective amount of a nucleoside analogue;and a therapeutically effective amount of an aryladamantane compoundthat is an inhibitor of sphingosine kinase, either sphingosine kinase 1(SK1) or sphingosine kinases 2 (SK2). In an embodiment, the serineprotease inhibitor is upamostat. In an embodiment, the nucleosideanalogue is brivudine In an embodiment, the aryladamantane compound is[3-(4-chlorophenyl)-adamantane-1-carboxylic acid(pyridin-4-ylmethyl)amide] also known as “ABC294640”. In an embodiment,the aryladamantane compound is ABC294735.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount of aserine protease inhibitor and a therapeutically effective amount of anucleoside analogue. In an embodiment, the serine protease inhibitor isupamostat. In an embodiment, the nucleoside analogue is brivudine.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount of aserine protease inhibitor and a therapeutically effective amount of anaryladamantane compound that is an inhibitor of sphingosine kinase,either sphingosine kinase 1 (SK1) or sphingosine kinases 2 (SK2). In anembodiment, the serine protease inhibitor is upamostat. In anembodiment, the aryladamantane compound is[3-(4-chlorophenyl)-adamantane-1-carboxylic acid(pyridin-4-ylmethyl)amide] also known as “ABC294640”. In an embodiment,the aryladamantane compound is ABC294735.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount of anucleoside analogue and a therapeutically effective amount of anaryladamantane compound that is an inhibitor of sphingosine kinase,either sphingosine kinase 1 (SK1) or sphingosine kinases 2 (SK2). In anembodiment, the nucleoside analogue is brivudine. In an embodiment, thearyladamantane compound is [3-(4-chlorophenyl)-adamantane-1-carboxylicacid (pyridin-4-ylmethyl)amide] also known as “ABC294640”. In anembodiment, the aryladamantane compound is ABC294735.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount of anucleoside analogue; a therapeutically effective amount of a serineprotease; and a therapeutically effective amount of an aryladamantanecompound that is an inhibitor of sphingosine kinase, either sphingosinekinase 1 (SK1) or sphingosine kinases 2 (SK2). In an embodiment, thenucleoside analogue is brivudine. In an embodiment, the serine proteaseinhibitor is upamostat. In an embodiment, the aryladamantane compound is[3-(4-chlorophenyl)-adamantane-1-carboxylic acid(pyridin-4-ylmethyl)amide] also known as “ABC294640”. In an embodiment,the aryladamantane compound is ABC294735.

In an embodiment, a combination cancer therapy of the present disclosureincludes administration of a therapeutically effective amount of anucleoside analogue and a therapeutically effective amount of anaryladamantane compound that is an inhibitor of sphingosine kinase,either sphingosine kinase 1 (SK1) or sphingosine kinases 2 (SK2). In anembodiment, the nucleoside analogue is brivudine. In an embodiment, thearyladamantane compound is [3-(4-chlorophenyl)-adamantane-1-carboxylicacid (pyridin-4-ylmethyl)amide] also known as “ABC294640”. In anembodiment, the aryladamantane compound is ABC294735.

In an embodiment, a pharmaceutical composition of the present inventioncomprises two or more agents together with one or more pharmaceuticallyacceptable carrier thereof and optionally one or more other therapeuticingredients. The carrier must be “acceptable” in the sense of beingcompatible with the other ingredients of the formulation and notdeleterious to the recipient thereof. Proper formulation is dependentupon the route of administration chosen. Any of the well-knowntechniques, carriers, and excipients may be used as suitable and asunderstood in the art; e.g., in Remington's Pharmaceutical Sciences. Thepharmaceutical compositions of the present disclosure may bemanufactured in a manner that is itself known, e.g., by means ofconventional mixing, dissolving, granulating, levigating, emulsifying,encapsulating, entrapping or compression processes.

In an embodiment, a pharmaceutical composition of the present inventionmay conveniently be presented in unit dosage form and may be prepared byany of the methods well known in the art of pharmacy. All methodsinclude the step of bringing into association an agent of the subjectdisclosure or a pharmaceutically acceptable salt, ester, analog, prodrugor solvate thereof (“active ingredient”) with the carrier whichconstitutes one or more accessory ingredients. In general, thecompositions are prepared by uniformly and intimately bringing intoassociation the active ingredient with liquid carriers or finely dividedsolid carriers or both and then, if necessary, shaping the product intothe desired composition.

In an embodiment, pharmaceutical compositions of the present disclosuresuitable for oral administration may be presented as discrete units suchas capsules, cachets or tablets each containing a predetermined amountof the active ingredients; as a powder or granules; as a solution or asuspension in an aqueous liquid or a non-aqueous liquid; or as anoil-in-water liquid emulsion or a water-in-oil liquid emulsion.

Pharmaceutical preparations which can be used orally include tablets,push-fit capsules made of gelatin, as well as soft, sealed capsules madeof gelatin and a plasticizer, such as glycerol or sorbitol. Tablets maybe made by compression or molding, optionally with one or more accessoryingredients. Compressed tablets may be prepared by compressing in asuitable machine the active ingredient in a free-flowing form such as apowder or granules, optionally mixed with binders, inert diluents, orlubricating, surface active or dispersing agents. Molded tablets may bemade by molding in a suitable machine a mixture of the powdered compoundmoistened with an inert liquid diluent. The tablets may optionally becoated or scored and may be formulated so as to provide slow orcontrolled release of the active ingredient therein. All compositionsfor oral administration should be in dosages suitable for suchadministration. The push-fit capsules can contain the active ingredientsin admixture with filler such as lactose, binders such as starches,and/or lubricants such as talc or magnesium stearate and, optionally,stabilizers. In soft capsules, the active compounds may be dissolved orsuspended in suitable liquids, such as fatty oils, liquid paraffin, orliquid polyethylene glycols. In addition, stabilizers may be added.Dragee cores are provided with suitable coatings. For this purpose,concentrated sugar solutions may be used, which may optionally containgum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethyleneglycol, and/or titanium dioxide, lacquer solutions, and suitable organicsolvents or solvent mixtures. Dyestuffs or pigments may be added to thetablets or dragee coatings for identification or to characterizedifferent combinations of active compound doses.

Agents of the Present Invention

5′ Substituted Nucleosides

The following are presented as non-limiting examples of 5′ substitutednucleosides of the present disclosure: 5-(2-bromovinyl-2′-deoxyuridine(BVDU), (E)-5-(2-bromovinyl)-1-.beta.-D-arabinofuranosyluracil,(E)-5-(2-bromovinyl-2′-deoxy-4′-thiouridine, 5-iodo-2′-deoxycytidine,5-iodo-2′-deoxyuridine, and 2′-deoxy-5-trifluoromethyluridine.Particularly preferred are Brivudine (BVDU) and (E)-5-(2-bromovinyl-)uracil (BVU). BVDU may be used in its salt form, in a protected form orin a prodrug form.

Brivudine (bromovinyldeoxyuridine or BVDU for short), is a nucleosideanalogue that interacts with two phenylalanine residues (Phe29 andPhe33) in the N-terminal domain of HspB1. The drug's full chemicaldescription is (E)-5-(2-bromovinyl)-2-deoxyuridine. Brivudine has beenshown to be an effective substance for preventing or reducing resistanceformation against treatment with cytostatic agents. The occurrence of“drug resistance” is the main reason for failure in cancer chemotherapy.Tumors which initially react sensitively to cytostatic agents veryfrequently recover after a certain treatment time and then are resistantto the effects of various types of antineoplastic drugs.

A non-limiting example of the prodrug form of BVDU is represented below:

Brivudine is represented below:

In an embodiment, a combination cancer therapy of the present disclosureincludes co-administering to a patient having cancer and in need oftreatment, brivudine, a salt thereof, or BVDU in protected or in prodrugform, along with at least one additional agent selected from Table 1,and in combination with at least one cytostatic agent selected from oneor more of alkaloids, alkylating agents, anti-metabolites, antibiotics,or cisplatin. During a method of treating cancer with a combinationtherapy that comprises BVDU, BVDU may be administered in an amounteffective to produce a concentration of 0.02 μg/ml to 10.0 μg/ml inblood. During a method of treating cancer with a combination therapythat comprises BVDU, BVDU may be administered in an amount effective toproduce a concentration of 0.05 μg/ml to 5 μg/ml in blood.

In an embodiment, a cancer combination therapy of the present disclosurefor reducing resistance in cytostatic treatment comprises delivering toa patient a therapeutically effective amount of at least one cytostaticagent, a therapeutically effective amount of BVDU, a salt thereof, orBVDU in protected form or prodrug form, and a therapeutically effectiveamount of at least one additional agent selected from Table 1.

In an embodiment, a cancer combination therapy of the present disclosurefor increasing the apoptotic effect of cytostatics after chemotherapycomprises administering (E)-5-(2-bromovinyl)-2′-deoxyuridine (BVDU),BVDU salt, or BVDU prodrug, or mixture thereof, the administering beingwithout administration of a cytostatic, during a recovery phase after acytostatic chemotherapy cycle, wherein the cytostatic chemotherapy cycleincludes administration of (a) BVDU, prodrug of the general formula I,or BVDU salt, or mixture thereof (b) at least one additional agentselected from Table 1; and (c) a cytostatic. In an embodiment, duringthe cytostatic chemotherapy cycle, administered amounts of cytostaticare increased over a period of the cytostatic chemotherapy cycle, andthe administered amount of BVDU, BVDU salt, or prodrug, or mixturethereof is constant. In an embodiment, the cytostatic chemotherapy cyclehas a duration of from 7 to 60 days. In an embodiment, the recoveryphase has a duration of from 3 to 10 days.

Urokinase Inhibitors

Upamostat (“WX-671” or “Mesupron”) has been shown to inhibit theurokinase-type plasminogen activator (uPA) system. Upamostat is a serineprotease inhibitor. After oral administration, serine protease inhibitorWX-671 is converted to the activeNα-(2,4,6-triisopropylphenylsulfonyl)-3-amidino-(L)-phenylalanine-4-ethoxycarbonylpiperazide(“WX-UK1”), which inhibits several serine proteases, particularly uPA.The drug's full chemical description is (S)-ethyl4-(3-(3-(N-hydroxycarbamimidoyl)phenyl)-2-(2,4,6-triisopropylphenylsulfonamido)propanoyl)piperazine-1-carboxylate.

Upamostat is represented by the following formula:

In an embodiment, a combination cancer therapy of the present disclosureincludes co-administering to a patient having cancer and in need oftreatment, upamostat, along with at least one additional agent selectedfrom Table 1. During a method of treating cancer with a combinationtherapy that comprises upamostat, upamostat may be administered orallyat a dose of about 0.5 mg/kg to about 1.1 mg/kg. In an embodiment,upamostat is administered orally at a daily dose of between about 200 mgto 400 mg. In an embodiment, upamostat is administered orally at a dailydose of between about 150 mg to 550 mg. In an embodiment, upamostat isadministered orally at a daily dose of between about 200 mg to 550 mg.In an embodiment, upamostat is administered orally at a daily dose ofbetween about 250 mg to 550 mg. In an embodiment, upamostat isadministered orally at a daily dose of between about 300 mg to 550 mg.In an embodiment, upamostat is administered orally at a daily dose ofbetween about 350 mg to 550 mg. In an embodiment, upamostat isadministered orally at a daily dose of between about 400 mg to 550 mg.In an embodiment, upamostat is administered orally at a daily dose ofbetween about 450 mg to 550 mg. In an embodiment, upamostat isadministered orally at a daily dose of between about 500 mg to 550 mg.In an embodiment, upamostat is administered orally at a daily dose ofbetween about 200 mg to 550 mg. In an embodiment, upamostat isadministered orally at a daily dose of between about 200 mg to 500 mg.In an embodiment, upamostat is administered orally at a daily dose ofbetween about 200 mg to 450 mg. In an embodiment, upamostat isadministered orally at a daily dose of between about 200 mg to 350 mg.In an embodiment, upamostat is administered orally at a daily dose ofbetween about 200 mg to 300 mg. In an embodiment, upamostat isadministered orally at a daily dose of between about 200 mg to 250 mg.In an embodiment, upamostat is administered orally at a daily dose ofbetween about 500 mg to 1000 mg. In an embodiment, upamostat isadministered orally at a daily dose of between about 750 mg to 1000 mg.In an embodiment, upamostat is administered orally at a daily dose ofbetween about 500 mg to 750 mg.

Clofazimine

The anti-leprosy drug Clofazimine is known to inhibit respiratoryfunction and hence energy metabolism in yeast and in transformedfibroblasts. Clofazimine is represented by the following formula:

Clofazimine has been shown to inhibit the growth rate of tumor cellsboth in vitro and in vivo. In an embodiment, a combination cancertherapy of the present disclosure includes co-administering to a patienthaving cancer and in need of treatment clofazimine, along with at leastone additional agent selected from Table 1. In an embodiment,clofazimine is administered orally to a patient as a component of asolid oral dosage form. In an embodiment, the dosage of clofazimine perday is from about 50 mg/day to about 580 mg/day. In an embodiment, themaximum dosage of clofazimine is 100 mg/day till recovery.

Rifabutin

Rifabutin is represented by the following formula:

In an embodiment, a combination cancer therapy of the present disclosureincludes co-administering to a patient having cancer and in need oftreatment rifabutin, along with at least one additional agent selectedfrom Table 1. In an embodiment, rifabutin is administered orally to apatient as a component of a solid oral dosage form. In an embodiment,the dosage of rifabutin per day is from about 80 mg/day to about 480mg/day. In an embodiment, the maximum dosage of rifabutin is 480 mg/daytill recovery. In an embodiment, rifabutin is administered orally as a150 mg tablet twice per day. In an embodiment, rifabutin is administeredorally as a 300 mg tablet once per day. In an embodiment, rifabutin isadministered as a component of a solid oral dosage form comprising from45 mg to 60 mg of rifabutin per dosage form, for up to six times perday.

Clarithromycin

Clarithromycin is represented by the following formula:

In an embodiment, a combination cancer therapy of the present disclosureincludes co-administering to a patient having cancer and in need oftreatment clarithromycin, along with at least one additional agentselected from Table 1. In an embodiment, clarithromycin is administeredorally to a patient as a component of a solid oral dosage form. In anembodiment, clarithromycin is administered as an intravenous infusion toa patient.

In an embodiment, the dosage of clarithromycin per day is from about 180mg/day to about 1000 mg/day till recovery. In an embodiment, the maximumdosage of clarithromycin is 980-1000 mg/day till recovery. In anembodiment, two doses of 500 mg clarithromycin is administered as anintravenously (IV) infusion, using a solution concentration of about 2mg/ml. In an embodiment, 1 gram daily of clarithromycin can beadministered as an intravenously (IV) infusion for a period of from twodays to five days. In an embodiment, 1 gram daily of clarithromycin canbe administered as an intravenously (IV) infusion for a period of threedays. In an embodiment, clarithromycin is administered orally as a 500mg tablet twice per day. In an embodiment, clarithromycin isadministered as a component of a solid oral dosage form comprising from95 mg to 125 mg of clarithromycin per dosage form.

In an embodiment, a combination cancer therapy of the present disclosureincludes administering to a patient having cancer and in need oftreatment, rifabutin, clarithromycin, and clofazimine as a single solidoral dosage form. In an embodiment, a solid oral dosage form of thepresent disclosure comprises rifabutin, clarithromycin, clofazimine, anda pharmaceutically acceptable carrier, wherein the amount of clofazimineis 5-18% w/w relative to the amount of clarithromycin (such as, 7-16%,9-14%, 9-12%, 10-15%, or 0-11% w/w) and 10-25% w/w relative to theamount of rifabutin (such as, 12-25%, 12-23%, 15-25%, 15-23%, 18-25%,18-23%, 20-25%, 20-23%, or 21-23% w/w).

In an embodiment, a solid oral dosage form of the present disclosurecomprises rifabutin, clarithromycin, and clofazimine in a8-10:18-20:1-2.5 w/w/w ratio (for example, a 8.5-9.5:18.5-19.5:1.5-2.5w/w/w ratio or a 9:19:2 ratio, wherein each variable is free to vary 0.5or 0.25). In an embodiment, a solid oral dosage form of the presentdisclosure comprises rifabutin, clarithromycin, and clofazimine in abouta 9:19:2 w/w/w ratio, wherein each of the variables are free to vary ±2,1, 0.5, or 0.25 (e.g., 9±0.5:19±5:2±0.0.5). For example in anembodiment, a solid oral dosage form of the present disclosure comprises90 mg rifabutin (±30, 20, 10, 5, 2, or 1 mg), 190 mg clarithromycin(±60, 40, 20, 10, 5, 2, or 1 mg), and 20 mg clofazimine (±10, 7, 5, 2,or 1 mg). In an embodiment, a solid oral dosage form of the presentdisclosure comprises 45 mg rifabutin (±15, 10, 7, 5, 2, or 1 mg), 95 mgclarithromycin (±30, 20, 10, 5, 2, or 1 mg), and 10 mg clofazimine (±6,5, 2, or 1 mg).

In embodiment, a solid oral dosage form of the present disclosure havingrifabutin, clarithromycin and clofazimine further comprises anabsorption enhancer that may improve bioavailability of one or more ofthe active ingredients. The amount of absorption enhancer may between300-700% w/w relative to the amount of clofazimine including 400-600% or450-550% or 475-525%. In certain embodiments, the absorption enhancer ispolyethylene glycol (PEG), for example, polyethylene glycol having anaverage molecular weight of between 200-20,000 including between1000-15000 or 5000-12000 or 7000-9000 or 7500-8500, for example PEG8000.

In embodiment, a solid oral dosage form of the present disclosure thatincludes rifabutin, clarithromycin and clofazimine further comprises oneor more additional excipients, such as MCC-Tabulose type 200, MgStearate, SLS-Emal 10Pwd HD, a polysorbate (such as, polysorbate 80), ora combination thereof, including all of these. In some instances, thepresent compositions include both polyethylene glycol and a polysorbate,such as polysorbate 80, wherein the amount of polysorbate is 30-120% w/wrelative to the amount of clofazimine (such as 50-100%, 50-85%, or60-75%).

In an embodiment, a solid oral dosage form of the present disclosurethat includes rifabutin, clarithromycin and clofazimine furthercomprises one or more additional excipients, such as Microcrystallinecellulose (MCC) TABULOSE® SC 200), Mg Stearate, Sodium Lauryl Sulfate(SLS) EMAL® 10Pwd HD, a polysorbate (such as, polysorbate 80), or acombination thereof, including all of these. In some instances, thepresent compositions include both polyethylene glycol and a polysorbate,such as polysorbate 80, wherein the amount of polysorbate is 30-120% w/wrelative to the amount of clofazimine (such as 50-100%, 50-85%, or60-75%).

In an embodiment, a pharmaceutical composition of the present inventioncomprises a capsule having 10 mg clofazimine, 95 mg of clarithromycinand 45 mf of rifabutin together with various excipients, known asRHB-104. In an embodiment, a RHB-104 capsule of the present inventionincludes the following components:

Composition of RHB-104 Capsules

Ingredient(Grade) Function mg per capsule % Clofazimine (USP/Ph.Eur.).Active 10.00 3.23 Rifabutin (USP/Ph.Eur.) Active 45.00 14.53Clarithromycin Active 95.00 30.67 Polyethylene Glycol 8000 Dispersing50.00 16.14 (NF/Ph.Eur.) Agent Polysorbate 80 (NF/Ph.Eur.) Wetting Agent6.66 2.15 Microcrystalline Cellulose 200 Diluent 28.00 9.04 (NF-Ph.Eur.)Magnesium Stearate, vegetable Lubricant 4.65 1.51 grade (NF/Ph.Eur.)Sodium Lauryl Sulfate Wetting Agent 10.00 3.23 (NF/Ph.Eur.)Microcrystalline Cellulose 200 Diluent 60.42 19.51 Hard Gelatin Capsule(Mfg.Std) — 1 unit — Total 309.76 100

In an embodiment, a solid oral dosage form of the present disclosure isavailable in the form of a tablet or a capsule containing an active in apowdered form. In an embodiment, a solid oral dosage form of the presentdisclosure is in the form of a tablet or a capsule containing an activein a microencapsulated form. In an embodiment, a solid oral dosage formof the present disclosure is in the form of a tablet or a capsulecontaining an active in a microgranulated form.

Sphingosine Kinase Inhibitors

An aryladamantane compound of the present invention has been shown to becapable of selectively inhibiting SK2 activity in vitro. Examples ofaryladamantane compounds of the present invention are generallyrepresented by the formula below:

and pharmaceutically acceptable salts thereof, whereinL is a bond or is —C(R₃,R₄)—;X is —C(R₃, R₄)N(R₅)—, —C(O)N(R₄)—, —N(R₄)C(O)—, —C(R₄,R₅)—, —N(R₄)—,—O—, —S—, —C(O)—, —S(O)₂—, —S(O)₂N(R₄)— or —N(R₄)S(O)₂—;R₁ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, —COOH,—H, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl), —OC(O)alkyl, carbamoyl,mono or dialkylaminocarbamoyl, mono or dialkylcarbamoyl, mono ordialkylamino, aminoalkyl, mono- or dialkylaminoalkyl, thiocarbamoyl, ormono or dialkylthiocarbamoyl;R₂ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, —COOH,—OH, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl), —OC(O)alkyl,carbamoyl, mono or dialkylaminocarbamoyl, mono or dialkylcarbamoyl, monoor dialkylamino, aminoalkyl, mono- or dialkylaminoalkyl, thiocarbamoyl,mono or dialkylthiocarbamoyl, alkyl-S-alkyl, -heteroaryl-aryl,-alkyl-heteroaryl-aryl, —C(O)—NH-aryl, -alkenyl-heteroaryl,—C(O)-heteroaryl, or -alkenyl-heteroaryl-aryl;R₃ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, oxo(═O), —COOH, —OH, —SH, —S-alkyl, —CN—, —NO₂, —NH₂, —CO₂(alkyl),—OC(O)alkyl, carbamoyl, mono or dialkylaminocarbamoyl, mono ordialkylcarbamoyl, mono or dialkylamino, aminoalkyl, mono- ordialkylaminoalkyl, thiocarbamoyl, or mono or dialkylthiocarbamoyl;wherein the alkyl and ring portion of each of the above R₁, R₂, and R₃groups is optionally substituted with up to 5 groups that areindependently (C₁-C₆) alkyl, halogen, haloalkyl, —OC(O)(C₁-C₆ alkyl),—C(O)O(C₁-C₆ alkyl), —CONR′R″, —OC(O)NR′R″, —NR′C(O)R″, —CF₃, —OCF₃,—OH, C₁-C₆ alkoxy, hydroxyalkyl, —CN, —CO₂H, —SH, —S-alkyl, —SOR′R″,—SO₂R′, —NO₂, or NR′R″, wherein R′ and R″ are independently H or (C₁-C₆)alkyl, and wherein each alkyl portion of a substituent is optionallyfurther substituted with 1, 2, or 3 groups independently selected fromhalogen, CN, OH, and NH₂; and

R₄ and R₅ are independently H or alkyl, provided that when R₃ and R₄ areon the same carbon and R₃ is oxo, then R₄ is absent.

Aryladamantane compounds include compounds of the following formula I-1:

and pharmaceutically acceptable salts thereof, wherein:R₁ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, —COH,—OH, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl), —C(O)alkyl, carbamoyl,mono or dialkylaminocarbamoyl, mono or dialkylcarbamoyl, mono ordialkylamino, aminoalkyl, mono- or dialkylaminoalkyl, thiocarbamoyl, ormono or dialkylthiocarbamoyl; andR₂ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, —COH,—OH, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl), —OC(O)alkyl,carbamoyl, mono or dialkylaminocarbamoyl, mono or dialkylcarbamoyl, monoor dialkylamino, aminoalkyl, mono- or dialkylaminoalkyl, thiocarbamoyl,mono or dialkylthiocarbamoyl, alkyl-S-alkyl, -heteroaryl-aryl,-alkyl-heteroaryl-aryl, —NH-aryl, -alkenyl-heteroaryl, -heteroaryl,—NH-alkyl, —NH— cycloalkyl, or -alkenyl-heteroaryl-aryl,wherein the alkyl and ring portion of each of the above R₁, and R₂groups is optionally substituted with up to 5 groups that areindependently (C₁-C₆) alkyl, halogen, haloalkyl, —OC(O)(C₁-C₆ alkyl),—C(O)O(C₁-C₆ alkyl), —CONR′R″, —OC(O)NR′R″, —NR′C(O)R″, —CF₃, —OCF₃,—OH, C₁-C₆ alkoxy, hydroxyalkyl, —CN, —CO₂H, —SH, —S-alkyl, —SOR′R″,—SO₂R′, —NO₂, or NR′R″, wherein R′ and R″ are independently H or (C₁-C₆)alkyl, and wherein each alkyl portion of a substituent is optionallyfurther substituted with 1, 2, or 3 groups independently selected fromhalogen, CN, OR NH₂.Aryladamantane compounds include those of formula II:

and pharmaceutically acceptable salts thereof, wherein:Y is-C(R₄,R₅)—, —N(R₄)—, —O—, or —C(O)—;R₁ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, —COH,—OH, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl), —C(O)alkyl, carbamoyl,mono or dialkylaminocarbamoyl, mono or dialkylcarbamoyl, mono ordialkylamino, aminoalkyl, mono- or dialkylaminoalkyl, thiocarbamoyl, ormono or dialkylthiocarbamoyl;R₂ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, —COH,—OH, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl), —C(O)alkyl, carbamoyl,mono or dialkylaminocarbamoyl, mono or dialkylcarbamoyl, mono ordialkylamino, aminoalkyl, mono- or dialkylaminoalkyl, thiocarbamoyl,mono or dialkylthiocarbamoyl, alkyl-S-alkyl, -heteroaryl-aryl,-alkyl-heteroaryl-aryl, —C(O)—NH-aryl, -alkenyl-heteroaryl,—C(O)-heteroaryl, or -alkenyl-heteroaryl-aryl;R₃ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, oxo(═O), —COOH, —OH, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl),—OC(O)alkyl, carbamoyl, mono or dialkylaminocarbamoyl, mono ordialkylcarbamoyl, mono or dialkylamino, aminoalkyl, mono- ordialkylaminoalkyl, thiocarbamoyl, or mono or dialkylthiocarbamoyl;wherein the alkyl and ring portion of each of the above R₁, R₂, and R₃groups is optionally substituted with up to 5 groups that areindependently (C₁-C₆) alkyl, halogen, haloalkyl, —OC(O)(C₁-C₆ alkyl),—C(O)O(C₁-C₆ alkyl), —CONR′R″, —OC(O)NR′R″, —NR′C(O)R″, —CF₃, —OCF₃,—OH, C₁-C₆ alkoxy, hydroxyalkyl, —CN, —CO₂H, —SH, —S-alkyl, —SOR′R″,—SO₂R′, —NO₂, or NR′R″, wherein R′ and R″ are independently H or (C₁-C₆)alkyl, and wherein each alkyl portion of a substituent is optionallyfurther substituted with 1, 2, or 3 groups independently selected fromhalogen, CN, OH, NH₂; andR₄ and R₅ are independently H or alkyl.Compounds of the formula II include those wherein:Y is —C(R₄,R₅)— or —N(R₄)—;R₁ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, —COOH,—OH, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl), —OC(O)alkyl,carbamoyl, mono or dialkylaminocarbamoyl, mono or dialkylcarbamoyl, monoor dialkylamino, aminoalkyl, mono- or dialkylaminoalkyl, thiocarbamoyl,or mono or dialkylthiocarbamoyl;R₂ is H, alkyl, cycloalkyl, cycloalkylalkyl, alkenyl, alkynyl,heteroalkyl, aryl, alkylaryl, alkenylaryl, heterocyclyl, heteroaryl,alkylheteroaryl, heterocycloalkyl, alkyl-heterocycloalkyl, acyl, aroyl,halogen, haloalkyl, alkoxy, haloalkoxy, hydroxyalkyl, alkanoyl, —COOH,—OH, —SH, —S-alkyl, —CN, —NO₂, —NH₂, —CO₂(alkyl), —OC(O)alkyl,carbamoyl, mono or dialkylaminocarbamoyl, mono or dialkylcarbamoyl, monoor dialkylamino, aminoalkyl, mono- or dialkylaminoalkyl, thiocarbamoyl,mono or dialkylthiocarbamoyl, alkyl-S-alkyl, -heteroaryl-aryl,-alkyl-heteroaryl-aryl, —C(O)—NH-aryl, -alkenyl-heteroaryl,—C(O)-heteroaryl, or -alkenyl-heteroaryl-aryl;wherein the alkyl and ring portion of each of the above R₁ and R₂ groupsis optionally substituted with up to 5 groups that are independently(C₁-C₆) alkyl, halogen, haloalkyl, —OC(O)(C₁-C₆ alkyl), —C(O)O(C₁-C₆alkyl), —CONR₄R₅, —OC(O)NR₄R₅, —NR₄C(O)R₅, —CF₃, —OCF₃, —OH, C₁-C₆alkoxy, hydroxyalkyl, —CN, —CO₂H, —SH, —S-alkyl, —SOR₄R₅, —SO₂R₄R₅,—NO₂, or NR₄R₅, and wherein each alkyl portion of a substituent isoptionally further substituted with 1, 2, or 3 groups independentlyselected from halogen, CN, OH, NH₂;R₃ is H, alkyl, or oxo (═O); andR₄ and R are independently H or (C₁-C₆)alkyl.

Representative formula II compounds include:

Cmpd Chemical name Y R3 R1 R2 1 3-(4-Chloro-phenyl)- adamantane-1-carboxylic acidisopropylamide NH ═O

2 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acidcyclopropylamide NH═O

3 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(2-ethylsulfanyl-ethyl)- amide NH ═O

4 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acidphenylamide NH ═O

5 Adamantane-1- carboxylic acid(4- hydroxy-phenyl)-amide NH ═O H

6 3-(4-Chloro-phenyl)- adamantane-4- carboxylic acid(4-hydroxy-phenyl)-amide NH ═O

7 Acetic acid 4-{[3-(4- chloro-phenyl)- adamantane-1- carbonyl]-amino}-phenyl ester NH ═O

8 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(2,4-dihydroxy-phenyl)- amide NH ═O

9 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(3- hydroxymethyl-phenyl)-amide NH ═O

10 Adamantane-1- carboxylic acid(4- cyanomethyl-phenyl)- amide NH ═O H

11 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(4-cyanomethyl-phenyl)- amide NH ═O

12 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acidbenzylamide NH ═O

13 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4-tert-butyl-benzylamide NH ═O

14 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4- methylsulfamoyl-benzylamide NH ═O

15 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3- trifluoromethyl-benzylamide NH ═O

16 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4- trifluoromethyl-benzylamide NH ═O

17 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3,5-bis-trifluoromethyl- benzylamide NH ═O

18 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3-fluoro-5-trifluoromethyl- benzylamide NH ═O

19 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid2-fluoro-4-trifluoromethyl- benzylamide NH ═O

20 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3,5-difluoro-benzylamide NH ═O

21 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3,5-difluoro-benzylamide NH ═O

22 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3,4,5-trifluoro-benzylamide NH ═O

23 3-(4-Chloro-phenyl)- adamantane-1- carobxylic acid3- chloro-4-fluoro-benzylamide NH ═O

24 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4-fluoro-3-trifluoromethyl- benzylamide NH ═O

25 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid2- chloro-4-fluoro-benzylamide NH ═O

26 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4- chloro-3-trifluoromethyl- benzylamide NH ═O

27 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3-aminomethyl-2,4,5,6- tetrachloro- benzylamide NH ═O

28 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[1-(4-chloro-phenyl)-ethyl]- amide NH ═O

29 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[1-(4-bromo-phenyl)-ethyl]- amide NH ═O

30 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4- methanesulfonyl-benzylamide NH ═O

31 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4- dimethylamino-benzylamide NH ═O

32 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4-trifluoromethoxy- benzylamide NH ═O

33 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3-trifluoromethoxy- benzylamide NH ═O

34 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4-phenoxy-benzylamide NH ═O

35 Adamantane-1- carboxylic acid3,4- dihydroxy-benzylamide NH ═O H

36 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid3,4-dihydroxy-benzylamide NH ═O

37 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acidphenethyl-amide NH═O

38 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[2-(4-fluoro-phenyl)-ethyl]- amide NH ═O

39 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[2-(4-bromo-phenyl)-ethyl]- amide NH ═O

40 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[2-(4-hydroxy-phenyl)-ethyl]- amide NH ═O

41 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid4-phenoxy-benzylamide NH ═O

42 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[2-(3-bromo-4-methoxy- phenyl)-ethyl]-amide NH ═O

43 Adamantane-1- carboxylic acid[2-(3,4- dihydroxy-phenyl)- ethyl]-amideNH ═O H

44 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[2-(3,4-dihydroxy-phenyl)- ethyl]-amide NH ═O

45 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(2-benzo[1,3]dioxol-5-yl- ethyl)-amide NH ═O

46 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[2-(3-phenoxy-phenyl)- ethyl]-amide NH ═O

47 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[2-(4-phenoxy-phenyl)- ethyl]-amide NH ═O

48 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(3-phenyl-propyl)-amide NH ═O

49 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(biphenyl-4-ylmethyl)-amide NH ═O

50 Adamantane-1- carboxylic acid(1- methyl-piperidin-4-yl)- amide NH ═OH

51 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(1-methyl-piperidin-4-yl)- amide NH ═O

52 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(4-methyl-piperazin-1-yl)- amide NH ═O

53 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(3-tert-butylamino-propyl)- amide NH ═O

54 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(3-pyrrolidin-1-yl-propyl)- amide NH ═O

55 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[3-(2-oxo-pyrrolidin-1-yl)- propyl]-amide NH ═O

56 Adamantane-1- carboxylic acid[2-(1- methyl-pyrrolidin-2-yl)-ethyl]-amide NH ═O H

57 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[2-(1-methyl-pyrrolidin-2-yl)- ethyl]-amide NH ═O

58 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(2-morpholin-4-yl-ethyl)- amide NH ═O

59 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(2-piperazin-1-yl-ethyl)- amide NH ═O

60 Adamantane-1- carboxylic acid(pyridin- 4-ylmethyl)-amide NH ═O H

61 3-(4-Fluoro-phenyl)- adamantane-1- carboxylic acid(pyridin-4-ylmethyl)-amide NH ═O

62 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(pyridin-4-ylmethyl)-amide NH ═O

63 Adamantane-1- carboxylic acid(pyridin- 4-ylmethyl)-amide NH ═O H

64 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(2-pyridin-4-yl-ethyl)- amide NH ═O

65 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(3-imidazol-1-yl-propyl)- amide NH ═O

66 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(2-methyl-1H-indol-5-yl)- amide NH ═O

67 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(1H-tetrazol-5-yl)-amide NH ═O

68 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(9-ethyl-9H-carbazol-3-yl)- amide NH ═O

69 Adamantane-1- carboxylic acid[4-(4- chloro-phenyl)-thiazol-2-yl]-amide NH ═O H

70 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid[4-(4-chloro-phenyl)-thiazol- 2-yl]-amide NH ═O

71 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acidbenzothiazol-2-ylamide NH ═O

72 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(5-chloro-benzooxazol-2- yl)-amide NH ═O

73 3-(4-Chloro-phenyl)- adamantane-1- carboxylic acid(9H-purin-6-yl)-amide NH ═O

75 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- isopropyl-amine NH H

76 4- and -phenol NH H

77 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (4-trifluoromethyl-benzyl)-amine NH H

78 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (2-fluoro-4-trifluoromethyl- benzyl)-amine NH H

79 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (4-fluoro-3-trifluoromethyl- benzyl)-amine NH H

80 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (4-trifluoromethoxy-benzyl)-amine NH H

81 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- [2-(3-phenoxy-phenyl)-ethyl]-amine NH H

82 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (1-methyl-piperidin-4-yl)-amine NH H

83 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (4-methyl-piperazin-1-yl)-amine NH H

84 N-tert-Butyl-N′-[3-(4- chloro-phenyl)- adamantan-1-ylmethyl]-propane-1,3-diamine NH H

85 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (3-pyrrolidin-1-yl-propyl)-amine NH H

86 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- [2-(1-methyl-pyrrolidin-2-yl)-ethyl]- amine NH H

87 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (2-morpholin-4-yl-ethyl)-amine NH H

88 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- pyridin-4-ylmethyl-amine NH H

89 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- (9-ethyl-9H-carbazol-3-yl)-amine NH H

90 [3-(4-Chloro-phenyl)- adamantan-1-ylmethyl]- [5-(4-chloro-phenyl)-thiazol-2-yl]-amine NH H

91 1-[3-(4-Chloro-phenyl)- adamantan-1-yl]- ethylamine NH CH3

H 92 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]ethyl}-isopropyl- amine NHCH3

93 Phenyl-[1-(3-phenyl- adamantan-1-yl)-ethyl]- amine NH CH3

94 {1-[3-(4-Fluoro- phenyl)-adamantan-1- yl]-ethyl}-phenyl-amine NH CH3

95 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-phenyl-amine NH CH3

96 (1-Adamantan-1-yl- ethyl)-benzyl-amine NH CH3 H

97 Benzyl-[1-(3-phenyl- adamantan-1-yl)-ethyl]- amine NH CH3

98 Benzyl-{1-[3-(4-fluoro- phenyl)-adamantan-1- yl]-ethyl}-amine NH CH3

99 Benzyl-{1-[3-(4-chloro- phenyl)-adamantan-1- yl]-ethyl}-amine NH CH3

100 {1-[3-(4-chloro- phenyl)-adamantan-1- yl]-ethyl}-amine NH CH3

101 [1-(4-Bromo-phenyl)- ethyl]-{1-[3-(4-chloro- phenyl)-adamantan-1-yl]-ethyl}-amine NH CH3

102 (1-Adamantan-1-yl- ethyl)-[2-(4-bromo- phenyl)-ethyl]-amine NH CH3 H

103 [2-(4-Bromo-phenyl)- ethyl]-{1-[3-(4-chloro- phenyl)-adamantan-1-yl]ethyl}-amine NH CH3

104 (1-Adamantan-1-yl- ethyl)-(1-methyl- piperidin-4-yl)-amine NH CH3 H

105 (1-Methyl-piperidin-4- yl)-[1-(3-phenyl- adamantan-1-yl)-ethyl]-amine NH CH3

106 {1-[3-(4-Fluoro- phenyl)-adamantan-1- yl]-ethyl}-(1-methyl-piperidin-4-yl)-amine NH CH3

107 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(1-methyl-piperidin-4-yl)-amine NH CH3

108 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(4-methyl-piperazin-1-yl)-amine NH CH3

109 {1-[3-(Phenyl)- adamantan-1-yl]-ethyl}- pyridin-4-ylmethyl- amine NHCH3

110 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(6-chloro-pyridin-3-ylmethyl)- amine NH CH3

111 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(1-pyridin-4-yl-ethyl)-amine NH CH3

112 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(3H-imidazol-4-ylmethyl)- amine NH CH3

113 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(2-methyl-1H-indol-5-yl)-amine NH CH3

114 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(9-ethyl-9H-carbazol-3-yl)-amine NH CH3

115 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(9-ethyl-9H-carbazol-3-ylmethyl)- amine NH CH3

116 9-Ethyl-9H-carbazol- 3-carboxylic acid{1-[3- (4-chloro-phenyl)-adamantan-1-yl]-ethyl}- amide NH CH3

117 1-{1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-3-(4-chloro-3-trifluoromethyl- phenyl)-urea NH CH3

118 1-{1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-3-(4-chloro-3-trifluoromethyl- phenyl)-urea NH CH3

119 (4-Bromo-thiophen-2- ylmethyl)-{1-[3-(4- chloro-phenyl)-adamantan-1-yl]-ethyl}- amine NH CH3

120 {1-[3-(4-Chloro- phenyl)-adamantan-1- yl]-ethyl}-(4-phenyl-thiophen-2-ylmethyl)- amine NH CH3

Representative formula I-1 compounds include:

Cmpd Chemical name R1 R2 121 3-Phenyl-adamantane-1-carboxylicacid

OH 122 3-(4-Fluoro-phenyl)-adamantane-1- carboxylic acid

OH 123 3-(4-Chloro-phenyl)-adamantane-1- carboxlic acid

OH 124 1-Adamantan-1-yl-ethanone H CH3 1251-(3-Phenyl-adamantan-1-yl)-ethanone

CH3 126 1-[3-(4-Fluoro-phenyl)-adamantan-1- yl]-ethanone

CH3 127 1-[3-(4-Chloro-phenyl)-adamantan-1- yl]-ethanone

CH3 128 2-(Adamantane-1-carbonyl)- malonicacid dimethyl ester H

129 2-[3-(4-Chloro-phenyl)-adamantan-1- carbonyl]-malonic aciddimethylester

130 3-(4-Chloro-phenyl)-1-[3-(4-chloro-phenyl)-adamantan-1-yl]-propenone

131 4-{3-[3-(4-Chloro-phenyl)-adamantan-1-yl]-3-oxo-propenyl}-benzonitrile

132 1-[3-(4-Chloro-phenyl)-adamantan-1-yl]-3-(4-hydroxy-phenyl)-propenone

133 1-[3-(4-Chloro-phenyl)-adamantan-1- yl]-3-naphthalen-2-yl-propenone

134 1-[3-(4-Chloro-phenyl)-adamantan-1-yl]-3-(6-chloro-pyridin-3-yl)-propenone

135 1-[3-(4-Chloro-phenyl)-adamantan-1-yl]-3-(1H-imidazol-4-yl)-propenone

136 1-[3-(4-Chloro-phenyl)-adamantan-1-yl]-3-(9-ethyl-9H-carbazol-3-yl)- propenone

137 1-[3-(4-Chloro-phenyl)-adamantan-1- yl]-3-(4-phenyl-thiophen-2-yl)-propenone

A particularly preferred aryladamantane compound of the presentinvention is illustrated below and referred to as ABC294640[3-(4-chlorophenyl)adamantane-1-carboxylicacid(pyridin-4-ylmethyl)amide]:

In an embodiment, an aryladamantane compound of the present invention isselected from a compound of Formula 8:

and pharmaceutically acceptable salts thereof, wherein

-   -   R₁ is H, Cl or F;    -   R₂ is H or alkyl;    -   m is 0, 1 or 2;    -   n is 1, 2, 3, 4 or 5;    -   each R₃ is independently H, —C(O)alkyl, —C(O)CH₂CH₂C(O)OH, R₄,        —C(O)NR₅R₆, —P(O)(OR₇)₂ or glucosyl, provided that at least one        R₃ is not H,    -   wherein        -   R₄ is a natural or unnatural amino acid linked through the            carboxyl moiety as an ester,        -   R₅ is H or alkyl,        -   R₆ is H or alkyl, and    -   each R₇ is independently H or alkyl.        In certain embodiments of the compounds of formula (I) as        described above, the

moiety is a catechol with substitution at least one catechol —OH. Forexample, in one embodiment, the

moiety has the structure

In one particularly preferred embodiment of the compounds of formula (I)as described above, the

moiety has the structure

In one especially preferred embodiment of the invention, compounds offormula (I) have R₁═Cl, R₂═H, m=2, n=2, and each R₃═—C(O)alkyl,especially —C(O)CH₃.For example, compounds of the invention include:

-   Acetic acid    2-acetoxy-5-(2-{[3-(4-chlorophenyl)-adamantane-1-carbonyl]-amino}ethyl)phenyl    ester;-   Propionic acid    2-propionyloxy-5-(2-{[3-(4-chlorophenyl)-adamantane-1-carbonyl]-amino}ethyl)phenyl    ester;-   Butyric acid    2-butyryloxy-5-(2-{[3-(4-chlorophenyl)-adamantane-1-carbonyl]-amino}ethyl)phenyl    ester;-   Isobutyric acid    5-(2-{[3-(4-chlorophenyl)adamantane-1-carbonyl]amino}ethyl)-2-hydroxyphenyl    ester; and-   2-Amino-3-methyl-butyric acid    5-(2-{[3-(4-chlorophenyl)adamantane-1-carbonyl]amino}ethyl)-2-hydroxyphenyl    ester.

A particularly preferred aryladamantane compound of the presentinvention is illustrated below and referred to as ABC294735:

Solid forms for oral administration may contain pharmaceuticallyacceptable binders, sweeteners, disintegrating agents, diluents,flavorings, coating agents, preservatives, lubricants, and/or time delayagents. Suitable binders include gum acacia, gelatin, corn starch, gumtragacanth, sodium alginate, carboxymethylcellulose or polyethyleneglycol (PEG). Suitable sweeteners include sucrose, lactose, glucose,aspartame or saccharine. Suitable disintegrating agents include cornstarch, methylcellulose, polyvinylpyrrolidone, xanthan gum, bentonite,alginic acid or agar. Suitable diluents include lactose, sorbitol,mannitol, dextrose, kaolin, cellulose, calcium carbonate, calciumsilicate or dicalcium phosphate. Suitable flavoring agents includepeppermint oil, oil of wintergreen, cherry, orange, or raspberryflavoring. Suitable coating agents include polymers or copolymers ofacrylic acid and/or methacrylic acid and/or their esters, waxes, fattyalcohols, zein, shellac or gluten. Suitable preservatives include sodiumbenzoate, vitamin E, alpha-tocopherol, ascorbic acid, methyl paraben,propyl paraben or sodium bisulphite. Suitable lubricants includemagnesium stearate, stearic acid, sodium oleate, sodium chloride ortalc. Suitable time delay agents include glyceryl monostearate orglyceryl distearate.

Solid forms for oral administration may contain pharmaceuticallyacceptable binders, sweeteners, disintegrating agents, diluents,flavorings, coating agents, preservatives, lubricants, and/or time delayagents. Suitable binders include gum acacia, gelatin, corn starch, gumtragacanth, sodium alginate, carboxymethylcellulose or polyethyleneglycol (PEG). Suitable sweeteners include sucrose, lactose, glucose,aspartame or saccharine. Suitable disintegrating agents include cornstarch, methylcellulose, polyvinylpyrrolidone, xanthan gum, bentonite,alginic acid or agar. Suitable diluents include lactose, sorbitol,mannitol, dextrose, kaolin, cellulose, calcium carbonate, calciumsilicate or dicalcium phosphate. Suitable flavoring agents includepeppermint oil, oil of wintergreen, cherry, orange, or raspberryflavoring. Suitable coating agents include polymers or copolymers ofacrylic acid and/or methacrylic acid and/or their esters, waxes, fattyalcohols, zein, shellac or gluten. Suitable preservatives include sodiumbenzoate, vitamin E, alpha-tocopherol, ascorbic acid, methyl paraben,propyl paraben or sodium bisulphite. Suitable lubricants includemagnesium stearate, stearic acid, sodium oleate, sodium chloride ortalc. Suitable time delay agents include glyceryl monostearate orglyceryl distearate.

Compounds of the invention determined to be effective for the preventionor treatment of disease or disorders in animals, e.g., rodents, dogs,and monkeys, may also be useful in treatment of tumors in humans. Thoseskilled in the art of treating tumors in humans will know, based upondata obtained in animal studies, the dosage and route of administrationof the compounds to humans. In general, the dosage and route ofadministration in humans is expected to be similar to that in animals.

A method of assessing the efficacy of a treatment in a subject includesdetermining the pre-treatment extent of a cancer by methods well knownin the art (e.g., determining tumor size or screening for cancermarkers) and then administering a cancer therapy of the presentinvention to the subject. After an effective treatment period after theadministration of the combination therapy (e.g., 1 day, 1 week, 2 weeks,one month, six months), the extent of the cancer is determined again. Inan embodiment, the modulation (e.g., decrease) of the extent ofinvasiveness of the cancer indicates efficacy of the treatment. Theextent or invasiveness of the cancer may be determined periodicallythroughout treatment. For example, the extent or invasiveness of thecancer may be checked every few hours, days or weeks to assess thefurther efficacy of the treatment. A decrease in extent or invasivenessof the cancer indicates that the treatment is efficacious.

EXAMPLES In Vivo Screening of Four Selected Patient-Derived PancreaticCancer Xenografts for Sensitivity to a Combination Cancer Therapy of thePresent Disclosure Comprising Rifabutin, Clarithromycin, and Clofazimine

RHB-104 is a combination drug capsule composed of the three antibiotics:Rifabutin, Clofazimine and Clarithromycin, RedHill Biopharma Ltd, anddescribed above. In this study, the anti-tumor efficacy and tolerabilityof RHB-104 was screened in vivo in nude mice subcutaneously implantedwith four different patient-derived pancreatic cancer tumor xenografts(patient-derived tumor xenografts, PDXs). The four PAXF models wereselected based on IL6 and IL8 expression and on sensitivity to thestandard-of-care (SoC) compound gemcitabine. The four efficacyexperiments were preceded by a dose-finding study in tumor-free mice.

The aim of the efficacy studies was to screen for tumor sensitivitytowards treatment with RHB-104 as monotherapy in four different tumormodels. The selected tumor models were PAXF 546, PAXF 736, PAXF 1872 andPAXF 199. Each experiment consisted of two groups of three animalsreceiving oral treatment with RHB-104 or with the vehicle of RHB-104.Treatments were given orally twice daily for two weeks and were followedby a two week observation period. Relative tumor volumes (RTV) forcontrol (C) and treatment (T) mice were calculated. The mean RTV forcontrol and treatment mice for each study were calculated and theminimum T/C value based on RTVs and the vehicle group was used forevaluation of anti-tumor efficacy on the day of min. T/C. At the end ofthe experiment, tumors were collected and snap-frozen for furtheranalysis. This experiment allowed for the calculation of the tumorgrowth delay.

Study Design for Dose Finding Experiment

Group Total Daily Dose Schedule Appl. No. of ID Therapy [mg/kg/day][Dosing days] Route Animals 1 Vehicle 10 ml/kg/day 1-21 (h:0) p.o. 3 2RHB-104 36 1-21 (h:0) p.o. 3 3 RHB-104 36/2*36/36 (72 0(h:12)/1-20(h:0 +p.o. 3 mg/kg/day) 12)/21 (h:0) 4 RHB-104 54/2*54/54 (1080(h:12)/1-20(h:0 + p.o. 3 mg/kg/day) 12)/21 (h:0) Vehicle for RHB-104:ORA-Plus ®.

Study Design for Efficacy Experiments

Group Total Daily Dose Schedule Appl. No. of ID Therapy [mg/kg/day][Dosing days] Route Animals 1 Vehicle 10/2*10/10 0(h:12)/1-13(h:0 + p.o.3 ml/kg/day 12)/14 (h:0) 2 RHB-104 36/2*36/36 (72 0(h:12)/1-13(h:0 +p.o. 3 mg/kg/day) 12)/14 (h:0) Vehicle for RHB-104: ORA-Plus ®.

Details of Sample Collection

Group No. of Animals Type of Sample, Time or Time Frame Sample ID to beSampled Fixation After Last Treatment Amount All All Tumors, SF At theend of the Whole observation period tumor

ORA-Plus® (an oral suspending vehicle): provided as solution fromPerrigo, Habari; shipped and stored at ambient temperature.

RHB-104: provided as pills from Corealis Pharma; shipped at ambienttemperature, the pills were crushed with mortar and pestle and thepowder was combined and stored at ambient temperature prior to use.

RHB-104 (efficacy study): a dosing solution with a concentration of 3.6mg/ml, for dosing of RHB-104 at 36 mg/kg/dose, was prepared daily bydissolving 26.27 mg dry matter (corresponding to 8.64 mg API) in 2.4milliliter ORA-Plus® and stirred (vortexed) at room temperature for 5minutes followed by sonification until a homogenous suspension wasachieved. The dosing solution was stored at ambient temperature,protected from light and used within the same dosing day (vortexed againbefore second application).

RHB-104 (dose-finding study): a dosing solution with a concentration of3.6 mg/ml, for dosing of RHB-104 at 36 mg/kg/dose, was prepared daily bydissolving 39.4 mg dry matter (corresponding to 12.96 mg API) in 3.6milliliter ORA-Plus® and stirred (vortexed) at room temperature for 5minutes followed by sonification until a homogenous suspension wasachieved. The dosing solution was stored at ambient temperature,protected from light and used within the same dosing day (vortexed againbefore second application).

RHB-104 (dose-finding study): a dosing solution with a concentration of5.4 mg/ml, for dosing of RHB-104 at 54 mg/kg/dose, was prepared daily bydissolving 39.4 mg dry matter (corresponding to 12.96 mg API) in 2.4milliliter ORA-Plus® and stirred (vortexed) at room temperature for 5minutes followed by sonification until a homogenous suspension wasachieved. The dosing solution was stored at ambient temperature,protected from light and used within the same dosing day (vortexed againbefore second application).

All dosing solutions were administered at a dose volume of 10 ml/kg.

Immunodeficient rodents enable the xenotransplantation and growth ofhuman tumors. Subcutaneous tumor implantation is a well-described methodallowing visualization and quantification of tumor growth. Usually,female immunodeficient NMRI-Foxn1^(nu) mice are used. Male animals areused only if required by the tumor model (e.g. prostate cancer) or forother scientific reasons. The animals are delivered at the age of fourto six weeks and are used for implantation after at least one week ofquarantine. Only animals with unobjectionable health are selected toenter testing procedures. Animals used were NMRI nu/nu.

The tumor xenografts were derived from surgical specimens from cancerpatients. Following excision at surgery, tumor pieces are subcutaneouslyimplanted into immunodeficient mice and are therefore referred to aspatient tumor explants passaged subcutaneously in nude mice or aspatient-derived tumor xenografts (PDX). Establishment andcharacterization of the PDXs is performed following their primaryimplantation into immunodeficient mice (passage 1). The tumor xenograftsare passaged until establishment of a stable growth pattern. At thatpoint, master stocks of early passage PDXs are frozen in liquidnitrogen. Usually, a particular stock batch is only used for a limitednumber of further passages.

Tumor fragments were obtained from xenografts in serial passage in nudemice. After removal from donor mice, tumors were cut into fragments (3-4mm edge length) and placed in PBS containing 10%penicillin/streptomycin. Recipient animals were anesthetized byinhalation of isoflurane and received unilateral or bilateral tumorimplants subcutaneously in the flank. Tumor xenografts with a take rate<65% (Table 2) were implanted with one or two tumors per mouse and incase of a bilateral take, one of these tumors was explanted prior torandomization.

TABLE 2 Overview of Experiments Group Tumor Number Tumors MedianDesignation/ (Gender) of Implanted Number of Tumor Passage ¹ Animals perAnimal Animals Volume ² — 12 (female) 0 12 — PAXF 546/ 12 (female) 1 6133.5-153.5 8N4 PAXF 736/ 12 (female) 1 6 100.1-102.7 9N2 PAXF 1872/ 12(female) 1 6 105.0-107.6 6N2 PAXF 1998/ 12 (female) 1 6 116.5-120.3 5N2¹ The number preceding the N represents the total number of passages andthe number following the N represents the passage number after the lastfreeze/thaw cycle. ² Range at randomization [mm³]

Animals and tumor implants were monitored daily until clear signs ofbeginning solid tumor growth were detectable in a sufficient number ofanimals. At randomization, the volume of growing tumors was determined.Animals fulfilling the randomization criteria (i.e. bearing tumors of50-250 mm³, preferably 80-200 mm³) were then distributed intoexperimental groups, aiming at comparable median and mean group tumorvolumes of approximately 100-120 mm³. Animals not randomized areeuthanized. The day of randomization is designated as day 0 of anexperiment.

The percentage of all tumor implants suitable for randomization at thestandard volume is defined as the take rate according to the followingequation:

${{Take}\mspace{14mu}{{Rate}\mspace{14mu}\lbrack\%\rbrack}} = {\frac{{number}\mspace{14mu}{of}\mspace{14mu}{tumors}\mspace{14mu}{suitable}\mspace{14mu}{for}\mspace{14mu}{randomization}}{{total}\mspace{14mu}{number}\mspace{14mu}{of}\mspace{14mu}{implanted}\mspace{14mu}{fragments}} \times 100}$

A median take rate was calculated for characterization purposes (seeTable 3 for the median take rates of the PDXs used in the presentstudy). For the calculation of the number of animals and tumor fragmentsneeded at implantation, the median take rate was taken into account.

The time from implantation to randomization at a standard tumor volumeis expressed in days as “Induction time (IT)”. A median IT is calculatedfor characterization purposes (see Table 2 for median ITs of PDXs usedin the present study).

TABLE 3 Characteristics of the Human Tumor Xenografts Tumor Histology/Age (Gender) IT Td Designation Differentiation Origin Stage of PatientTR [%] [Days] [Days] PAXF 546 adenosquamous Metastasis M1 liver, 70(Male) 75 18 6.5 carcinoma peritoneum good PAXF 736 adeno carcinomaRecurrent M1 65 (Male) 77 18 8.5 poor PAXF 1872 adeno carcinoma PrimarypT1pN1pMx 39 (Female) 80 20 6.1 moderate PAXF 1998 adeno carcinomaPrimary pT3pN1pM1 74 (Male) 80 22 5.6 moderate (ADR) TR, take rate; IT,induction time; Td, tumor volume doubling time: typical values (median)

Animals were weighed twice a week, or daily if body weight losses inexcess of 15% were recorded. Relative body weights of individual animalswere calculated by dividing the individual body weight on Day X (BW_(x))by the individual body weight on Day 0 (BW₀) multiplied by 100%:

${{RBW}_{x}\lbrack\%\rbrack} = {\frac{{BW}_{x}\lbrack g\rbrack}{{BW}_{0}\lbrack g\rbrack} \times 100}$

Group median relative body weights were calculated as well, consideringonly animals that were alive on the day in question.

The absolute tumor volumes (ATVs) were determined by two-dimensionalmeasurement with a caliper on the day of randomization and then twiceweekly. Tumor volumes were calculated according to the formula:Tumor volume=(a×b ²)×0.5where a represents the largest and b the perpendicular tumor diameter ofthe tumor representing an idealized ellipsoid.

Relative volumes of individual tumors (individual RTVs) for Day x werecalculated by dividing the absolute individual tumor volume on Day x(T_(x)) by the absolute individual tumor volume of the same tumor on Day0 (To) multiplied by 100%:

${{RTV}_{x}\lbrack\%\rbrack} = \frac{T_{x} \times 100}{T_{0}}$

Group median RTV values were used for drawing growth curves and fortreatment evaluation for as long as at least 50% of the animals in agroup remain alive or a minimum of three animals.

For calculation of the group median tumor volumes the values fromanimals that were alive on the day in question were considered. Inaddition, tumor volumes of animals that were euthanized due to theirtumor load were carried forward using theLast-Observation-Carried-Forward (LOCF) methodology for as long as thisincreases the group median tumor volume.

Dosing in the present study was performed as described in Table 4. Thefirst day of dosing is either the day of randomization (day 0, seebelow) or the following day (day 1, but no later than 24 hours afterrandomization) as seen in Table 4.

The time of the first dose on a dosing day is designated as h:0.Multiple daily dosages of the same reagent are indicated with the timeinterval between therapies, e.g. h:0+12. Therapy with other reagents isindicated in relation to the first daily dose, e.g. h:8, whereapplicable.

TABLE 4 Anti-tumor Efficacy Minimum Dose Level Schedule T/C [%] EfficacyTd Tq Therapy¹ [mg/kg/day] [Day] Route (Day)² Rating [Days] [Days] TumorModel PAXF 546-Exp. Q255 Vehicle 10/2*10/10 0(h:12)/1- p.o. n/a n/a 5.118.5 control ml/kg/day 13(h:0 + 12)/14 (h:0) RHB-104 36/2*36/360(h:12)/1- p.o. 67.7 (28) − 6.4 20.8 13(h:0 + 12)/14 (h:0) Tumor ModelPAXF 736-Exp. Q256 Vehicle 10/2*10/10 0(h:12)/1- p.o. n/a n/a 4.5  8.6control ml/kg/day 13(h:0 + 12)/14 (h:0) RHB-104 36/2*36/36 0(h:12)/1-p.o. 71.1 (10) − 5.9 11.2 13(h:0 + 12)/14 (h:0) Tumor Model PAXF1872-Exp. Q257 Vehicle 10/2*10/10 0(h:12)/1- p.o. n/a n/a 3.7  8.2control ml/kg/day 13(h:0 + 12)/14 (h:0) RHB-104 36/2*36/36 0(h:12)/1-p.o. 58.3 (14) +/− 6.0 10.4 13(h:0 + 12)/14 (h:0) Tumor Model PAXF1998-Exp. Q258 Vehicle 10/2*10/10 0(h:12)/1- p.o. n/a n/a 3.5  9.3control ml/kg/day 13(h:0 + 12)/14 (h:0) RHB-104 36/2*36/36 0(h:12)/1-p.o. 86.4 (16) − 3.4  8.9 13(h:0 + 12)/14 (h:0) n/a, not applicable;n.r., not reached (i.e. group median RTVs always <200%/400%) Efficacymting: ++++, T/C < 5%, +++, T/C 5-<10%; ++, T/C 10-<25%; +, T/C 25-<50%;+/−, T/C: 50-65%; −, T/C ≥ 65% ¹Vehicle for RHB-104: ORA-Plus ®.²Minimum T/C values are calculated based on median values.

When considerable body weight loss is recorded in efficacy studies thefollowing measures are taken:

no therapy for individual animals with body weight loss >20%

daily body weight measurements of individual animals with body weightloss >15%

facilitated access to feed and water for animals with body weight loss>20%

resumption of dosing when individual animals have regained a relativebody weight of at least 85%

Efficacy experiments were generally terminated at the earliest fourweeks after the start of dosing, including a standard observation periodof two weeks after the end of treatment.

The maximum tolerated dose (MTD) is defined herein as the dose whichshall allow uninterrupted treatment of an animal with the respectivecompound according to the intended schedule, without applying doseadjustments or termination criteria. This definition may also be appliedto combination therapy regimens. Dose-finding studies are conducted intumor-free animals.

The overall survival rate (Table 5) was calculated by counting thenumber of animals that would have survived beyond the last experimentalday of each group and dividing them by the total number of animals inthe group. Animals that died or were euthanized on the last day of thegroup for any other reason than sample collection or termination of thegroup were not counted as survivors. The adjusted survival rate in Table6 is calculated by counting all surviving animals including those thatwere euthanized for tumor-related reasons and dividing them by the totalnumber of animals in the group. The following reasons for euthanasia areclassed as tumor-related: 1) tumors fulfilling volume-relatedtermination criteria including accessory tumors and 2) ulceratingtumors. Euthanasia of animals due to symptoms of tumor-induced cachexiais not counted as tumor-related.

TABLE 5 Body Weight Losses and Survival Rates Maximum Dose LevelSchedule Last Day Median BWL Overall Survival Therapy [mg/kg/day] [Day]of Group [%] (Day)¹ Rate ² Vehicle control 10 ml/kg/day 0-21 (h:0) 28n.r. 3/3 (100%) RHB-104 36 0-21 (h:0) 28 2.4 (1) 3/3 (100%) RHB-10436/2*36/36 0(h:12)/1- 28 n.r. 3/3 20(h:0 + 12)/21 (h:0) (100%) RHB-10454/2*54/54 0(h:12)/1- 28 n.r. 3/3 20(h:0 + 12)/21 (h:0) (100%) Vehiclefor RHB-104: ORA-Plus ®. ¹Day on which the minimum median body weightwas recorded; n.r., not relevant, no body weight loss recorded (i.e.group median RBWs always >100%). ² Number of animals that would havesurvived beyond the last experimental day over total number of animalsin the group. 3 Survival rate adjusted for (i.e. not counting) allanimals that were euthanized for tumor-related reasons.

TABLE 6 Median Body Weight Losses and Adjusted Survival Rates MaximumLast Median Overall Euthanasia for Adjusted Dose Level Schedule Day ofBWL [%] Survival Tumor-related Survival Therapy [mg/kg/day] [Day] Group(Day)¹ Rate ² Reasons (Day) Rate ³ Tumor Model PAXF 546*-Exp. Q255Vehicle 10/2*10/10 0(h:12)/1- 28 6.8 (28) 2/3 1× TV > 2000 mm³ 100%control ml/kg/day 13(h:0 + 12)/14 (h:0) (67%) (28) RHB- 36/2*36/360(h:12)/1- 28 0.7 (21) 2/3 1× TV > 2000 mm³ 100% 104 13(h:0 + 12)/14(h:0) (67%) (28) Tumor Model PAXF 736-Exp Q256 Vehicle 10/2*10/100(h:12)/1- 28 n.r. 1/3 2× TV > 2000 mm³ 100% control ml/kg/day 13(h:0 +12)/14 (h:0) (33%) (24,24) RHB- 36/2*36/36 0(h:12)/1- 28 n.r. 2/3 1×TV > 2000 mm³ 100% 104 13(h:0 + 12)/14 (h:0) (67%) (21) Tumor Model PAXF1872-Exp. Q257 Vehicle 10/2*10/10 0(h:12)/1- 28 1.0 (7)  1/3 2× TV >2000 mm³ 100% control ml/kg/day 13(h:0 + 12)/14 (h:0) (33%) (21, 21)RHB- 36/2*36/36 0(h:12)/1- 28 n.r. 2/3 1× TV > 2000 mm³ 100% 10413(h:0 + 12)/14 (h:0) (67%) (25) Tumor Model PAXF 1998-Exp. Q258 Vehicle10/2*10/10 0(h:12)/1- 27 2.3 (13) 1/3 2× TV > 2000 mm³ 100% controlml/kg/day 13(h:0 + 12)/14 (h:0) (33%) (20, 20) RHB- 36/2*36/360(h:12)/1- 27 n.r. 1/3 2× TV > 2000 mm³ 100% 104 13(h:0 + 12)/14 (h:0)(33%) (20, 20) Vehicle for RHB-104: ORA-Plus ®. ¹Day on which theminimum median body weight was recorded; n.r., not relevant, no bodyweight loss recorded (i.e. group median RBWs always >100%). ² Number ofanimals that would have survived beyond the last experimental day overtotal number of animals in the group. ³ Survival rate adjusted for (i.e.not counting) all animals that were euthanized for tumor-relatedreasons.

Tumor volume doubling/quadruplication time (Td/Tq) for test and controlgroups is defined as the time interval (in days) required for a group toreach a median RTV of 200%/400%. Data are presented in Table 4.

The test versus control value for a particular day (T/C in %) iscalculated from the ratio of the median RTV values of test versuscontrol groups on day x multiplied by 100%.

${T/{C_{x}\lbrack\%\rbrack}} = {\frac{{median}\mspace{14mu}{RTV}_{x}\mspace{14mu}{treated}\mspace{14mu}{group}}{{median}\mspace{14mu}{RTV}_{x}\mspace{14mu}{control}\mspace{14mu}{group}} \times 100}$

The minimum T/C value recorded for a particular test group during anexperiment represents the maximum anti-tumor efficacy for the respectivetreatment. Minimum T/C values are calculated if at least 50% and atleast three of the randomized animals in the test and in the controlgroup were alive on the day in question. The minimum T/C values arealways calculated without using the LOCF methodology.

Group minimum T/C values are used for efficacy rating as follows:

− Inactive T/C ≥ 65% +/ − Borderline efficacy 50% ≤ T/C < 65% + Moderateefficacy 25% ≤ T/C < 50% ++ High efficacy 10% ≤ T/C < 25% +++ Very highefficacy  5% ≤ T/C < 10% ++++ Complete remission T/C < 5%

Statistical significance of the anti-tumor efficacy was evaluated by anon-parametric Kruskal-Wallis test followed by Dunn's posttest.Individual RTVs of test and control groups are compared on days on whichthe minimum T/C values are achieved in the relevant test groups.Usually, statistical analysis is only carried out if at least 50% of theinitially randomized animals (and at least four animals) in a relevantgroup are still alive, in this study the group size is only threeanimals at randomization and the result of the statistical evaluation istherefore less reliable than it would be in a study with a larger groupsize. By convention, p-values ≤0.05 indicate significance of tumorinhibition.

An overview of the experiments is given in Table 3. The results aresummarized in Table 4 and in FIGS. 1-5 .

In this study, the anti-tumor efficacy of RHB-104 was assessed inmonotherapy in immunodeficient mice implanted subcutaneously with fourdifferent pancreatic PDXs. Groups of three mice were administered thecompound orally, twice daily, for two weeks followed by an observationperiod of two weeks. At the end of the experiment tumors from allanimals were collected and snap-frozen for further analysis. Theanti-tumor efficacy was evaluated as minimum T/C value and wascalculated from group median relative tumor volumes (RTVs) in thetreatment group compared to a control group that received the vehicle ofRHB-104 (ORA-Plus). Statistical significance of tumor growth inhibitionwas assessed on the day of min. T/C by a Kruskal-Wallis test of therelative tumor volumes followed by Dunn's post test. The efficacyexperiments were preceded by a dose-finding study in tumor-free mice,where groups of three mice were treated orally with RHB-104 for threeweeks at three different regimens. Either, a dose-level of 36 mg/kg wasgiven once daily, or a dose level of 36 mg/kg or 54 mg/kg was giventwice daily. Additionally, one group was treated with ORA-Plus®, thevehicle of RHB-104 (Group 1). As illustrated in FIGS. 6A-6E, RHB-104 waswell tolerated in tumor-free mice with regard to body weight losses andsurvival rates. As seen in FIG. 6A, a minor BWL of 2.4% on day 1 of thestudy was observed for the group treated once daily at a dose level of36 mg/kg (Group 2), no BWLs were observed in the other groups andsurvival rates were 100% in all four groups. Based on theseobservations, it was decided to dose RHB-104 at a dose level of 36 mg/kgtwice daily in the efficacy experiments with tumor-bearing mice.

Highest sensitivity to treatment with RHB-104 was observed in the PAXF1872 tumor model, where a min. T/C value of 58.3% was reached on thelast day of treatment and rated as anti-tumor efficacy. Treatments withRHB-104 in the other three tumor models resulted in min. T/C values of67.7%, 71.1% and 86.4% for the PAXF 546, PAXF 736 and PAXF 1998 tumormodels, respectively.

Table 4 and FIGS. 6A-6E summarize the results in body weight change,survival and observations. Treatments with RHB-104 were well toleratedwith BWLs≤0.7% and adjusted survival rates of 100% in all four tumormodels. The PAXF 546 tumor model is known to induce cachexia and here amoderate BWL of 6.8% was observed in the vehicle control group.

Treatments with RHB-104 were well tolerated with BWLs≤0.7% and adjustedsurvival rates of 100% in all four tumor models.

RHB-104 was tested orally at a twice-daily dose level of 36 mg/kg ingroups of three mice, anti-tumor efficacy was assessed as minimum T/Cvalue based on group median relative tumor volumes (RTV). Statisticalsignificance was evaluated by a Kruskal Wallis test of RTVs on the dayof min. T/C in comparison to a control group receiving the vehicle ofRHB-104. The treatment period lasted two weeks in the efficacyexperiments and was followed by a two week observation period,whereafter tumors were collected and snap-frozen for further analysis.In the dose-finding experiment the treatment lasted three weeks and wasfollowed by a one week observation period. Good tolerability of RHB-104was observed in the dose-finding study, where RHB-104 was tested ingroups of three mice at three different regimens, additionally, onegroup of three mice received ORA-Plus®, the vehicle of RHB-104. All fourgroups displayed BWLs≤2.4% and adjusted survival rates of 100%.

Effects of RHB-104 on LPS-Induced Cytokine Production in C57BL/6 Mice

This study was performed to evaluate the effects of RHB-104 (as detailedabove) dosed orally at 108 mg/kg on lipopolysaccharide (LPS)-inducedcytokine production in mice. The LPS-induced cytokine production modelin mice is commonly used to test the ability of compounds to suppressproduction of pro-inflammatory cytokines TNF and TL-6 in vivo.

In this model LPS is injected into mice intraperitoneally (i.p.) orintravenously. Two hours after the LPS injection, concentrations of IL-6and TNF reach peak levels in serum of the injected mice. At that timethe concentration of anti-inflammatory cytokine IL-10 is also increased,but the serum concentration of IL-10 peaks approximately 6 hours afterthe LPS administration.

30 female C57BL/6 mice, 11 weeks old, were dosed once with RHB-104, theninjected with LPS 1 hour later. 2 hours after LPS injection, mice werebled and serum was isolated. The concentration of cytokines in serum wasmeasured. Dexamethasone administered at 5 mg/kg i.p. was used aspositive control for suppression of the immune response. Dexamethasonesuppresses production of pro-inflammatory cytokines TNF and IL-6increases production of anti-inflammatory cytokine IL-10.

There were 3 groups in the study, according to Table 7 below:

TABLE 7 Study Design # Fre- Group mice Treatment Dose Route quencyVolume Purpose 1 10 Vehicle — p.o. Once 15 Negative (Ora-Plus) mL/kgcontrol 2 10 Dexa- 5 i.p. Once 10 Positive methasone mg/kg mL/kg control3 10 RHB-104 108 p.o. Once 15 Test mg/kg mL/kg

Serum concentrations of IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ and TNFwere measured using cytokine bead analysis (CBA) Th1/Th2/Th17 kit(Becton Dickinson). Concentrations of cytokines in serum between groupswere compared using 2-tailed Student's t-test.

Serum concentrations of IL-2, IL-4, IL-17 and IFN-γ were below detectionlevel in all groups, as expected for this model. Serum concentrations ofIL-6, TNF, and IL-10 are shown in Table 8 below and FIGS. 7, 8 and 9 .

TABLE 8 Serum Concentration of Cytokines Body IL-6 TNF IL-10 weight(pg/mL) ± (pg/mL) ± (pg/mL) ± Group (g) ± SD P value SD P value SD Pvalue SD P value 1 20.07 ± 0.89 5092 ± 1515 332 ± 148 76 ± 72 2 20.19 ±0.84 0.7610 1259 ± 295  0.0000* 35 ± 10 0.0000* 106 ± 66  0.3451 3 20.09± 0.96 0.9620 2618 ± 962  0.0004* 154 ± 62  0.0025* 63 ± 40 0.6133 p <0.05

In the serum of vehicle treated mice, concentrations of IL-6, TNF andIL-10 were as expected for this model (FIGS. 7-9 ).

In the dexamethasone treated group, serum concentrations orpro-inflammatory cytokines IL-6 and TNF were significantly lower than inthe vehicle treated group, as expected (FIGS. 7 and 8 ). The IL-10concentration was higher than in the vehicle group, but the differencewas not statistically significant (FIG. 9 ). These results confirm thatdexamethasone worked as a positive control.

RHB-104 treated mice had serum concentrations of IL-6 and TNFsignificantly lower than in the vehicle treated group (FIGS. 7 and 8 ).The concentration of IL-10 was not significantly different from thevehicle control mice (FIG. 9 ).

In Vitro Cytotoxicity Assay

The following experiment was performed to assess the potential ofcombination agents of the present disclosure for their capability ofinhibiting the growth or proliferation of pancreatic cancer cellscomprising contacting pancreatic cancer cells with effective amounts ofthe agents, alone and in combination, thereby inhibiting the growth orproliferation of the pancreatic cancer cells.

The present study investigated whetherclarithromycin+rifabutin+clofazimine (“Combo”) would be synergistic with[3-(4-chlorophenyl)-adamantane-1-carboxylic acid(pyridin-4-ylmethyl)amide] (“ABC2640”) against MIA PaCa-2, PANC-1, andHs 766T pancreatic cancer cell lines. Hs 766T is a cell line derivedfrom the lymph node metastasis of a 64-year-old male with pancreascarcinoma. MIA PaCa-2 is a cell line derived from the pancreasadenocarcinoma of a 65-year-old man who presented with abdominal painfor 6 months and a palpable upper abdominal mass. PANC-1 was culturedfrom a 56-year-old male with an adenocarcinoma in the head of thepancreas which invaded the duodenal wall.

The MTT assay is commonly used to determine cytotoxicity of potentialmedicinal agents, since these types of materials are expected tostimulate or inhibit cell viability and growth. Briefly, 3,000 cellswere plated/well-100 μl/well. After overnight, prior to the assay, 50 μlsupernatant was removed from each well. Each drug was added at 4× of thefinal concentration (in 50 μl). Total volume of each well was 200 μl. 4wells had been used as a control and contained no cells at all. Theplate was developed after being incubated for 3 days at 37° C. 20 μl ofPromega Substrate Cell Titer 96 Aqueous One Solution Reagent was addedto each well, incubated at 37° C. and read OD at 490 nm. The MTT test isbased on the enzymatic reduction of the tetrazolium salt MTT[3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazoliumbromide+++] inliving, metabolically active cells but not in dead cells. The reactionis carried out in situ in multiwell plates, and the reaction product, apurple-colored formazan soluble in dimethylsulfoxide, is measuredcolorimetrically, using a multiwell plate reader.

Results for Hs 766T Agent Concentration (μM) Toxicity (%) clarithromycin100 29 rifabutin 70 20 Clofazimine 5 62 Combo above 59 ABC640 25 17ABC640 50 72 UK-1 5 35 UK-1 10 28 UK-1 20 19 Combo + ABC₂₅ above 96Combo + ABC₅₀ above 95 Combo + UK-1₅ above 81 Combo + UK-1₁₀ above 93Combo + UK-1₂₀ above 96 Combo + UK-1₁₀ + ABC₂₅ above 96 Combo + UK-1₁₀ +ABC₅₀ above 95

Results for MIA PaCa-2 Agent Concentration (μM) Toxicity (%)clarithromycin 100 0 rifabutin 35 8 Clofazimine 5 4 Combo above 64ABC640 25 11 ABC640 50 92 UK-1 5 33 UK-1 10 0 UK-1 20 0 Combo + ABC₂₅above 96 Combo + ABC₅₀ above 96 Combo + UK-1₅ above 95 Combo + UK-1₁₀above 97 Combo + UK-1₂₀ above 97 Combo + UK-1₁₀ + ABC₂₅ above 96 Combo +UK-1₁₀ + ABC₅₀ above 97

Results for PANC-1 Agent Concentration (μM) Toxicity (%) clarithromycin100 7 rifabutin 70 0 Clofazimine 5 41 Combo above 79 ABC640 25 0 ABC64050 68 UK-1 5 0 UK-1 10 0 UK-1 20 14 Combo + ABC₂₅ above 86 Combo + ABC₅₀above 96 Combo + UK-1₅ above 70 Combo + UK-1₁₀ above 80 Combo + UK-1₂₀above 97 Combo + UK-1₁₀ + ABC₂₅ above 94 Combo + UK-1₁₀ + ABC₅₀ above 92

The inventors found additive to synergistic antitumor interactions ofthe agents tested in all three cell lines by MTT assays. Combinationtherapy using these agents may enhance the response rate of differentcancers to these drugs and may significantly reduce side effects bypermitting a lower therapeutic dose to be administered. These novelcombinations synergistically decrease cancer cell growth withoutincreasing the toxicity profile compared to the individual drugs.

In Vivo Assay of the uPA Inhibitor Prodrug WX-671 with Regard to TumorSpreading, Tumor Growth and Metastasizing in Rats Breast Cancer Model

Fragments of 10-25 mm³ of the BN472 breast cancer (Kort et al., J. Natl.Cancer Inst 72, 709-713, 1984) from a donor animal were implantedunderneath the fatty body of a mammary gland of groups (n=15 per group)of female brown Norwegian rats aged 7-8 weeks. The treatments started 72h after tumor implantation and were repeated daily until the animalswere sacrificed after 30 days. The control group (A) received 0.75 ml ofthe substance-free substance carrier solution consisting of 5% ethanol,5% D-mannitol and 5% Tween 20 in water orally by gavage. The treatmentgroups (B and C) received, orally by gavage, either 1 mg/kg (group B) or5 mg/kg (group C) WX-671 in a volume of 0.75 ml of substance carriersolution. The comparative group D received 1 mg/kg WX-UK1 dissolved in5% D-mannitol by intraperitoneal injection.

Growth of the inoculated tumors was determined in the dimensions lengthand width twice weekly, using a slide gauge. After the animals had beensacrificed, the therapy end points, tumor weight, weights of theaxillary and intraperitoneal lymph nodes and also the number ofmacroscopic lung metastases were determined.

In all experiments, treatment with WX-671 achieved a considerablereduction in the size and, respectively, the weight of the tumors and inthe number and, respectively, mass of metastases, in comparison with thecontrol group. In the mammary tumor model, the average tumor weights atthe end of the treatment were reduced in the WX-671-treated group bymore than 66% (p.o.) compared to the control, while an i.p. treatmentwith the comparative inhibitor substance WX-UK1 achieved only areduction by approx. 5%. The number of lung foci in the inhibitorprodrug-treated groups was reduced by more than 42% (p.o.) and theaverage weights of the axillary lymph nodes by more than 63% (p.o.).

The development of bodyweight increase and the comparison of organweights between inhibitor-treated and vehicle-treated groups gave noindication of a possible considerable toxicity of the inhibitor underthe conditions described.

Prophetic Example—In Vivo Assay of the SK2 Inhibitor ABC294640 and theuPA Inhibitor Prodrug WX-671 with Regard to Tumor Spreading, TumorGrowth and Metastasizing in Rats Breast Cancer Model

Fragments of 10-25 mm³ of the BN472 breast cancer (Kort et al., J. Natl.Cancer Inst 72, 709-713, 1984) from a donor animal are implantedunderneath the fatty body of a mammary gland of groups (n=15 per group)of female brown Norwegian rats aged 7-8 weeks. The treatments start 72 hafter tumor implantation and are repeated daily until the animals aresacrificed after 30 days. The control group (A) receives 0.75 ml of thesubstance-free substance carrier solution consisting of 5% ethanol, 5%D-mannitol and 5% Tween 20 in water orally by gavage. The treatmentgroups (B and C) receive, orally by gavage, either 50 mg/kg (group B) or100 mg/kg (group C) ABC294640 in a volume of 0.75 ml of substancecarrier solution. The treatment groups (D and E) receive, orally bygavage, either 1 mg/kg (group D) or 5 mg/kg (group E) WX-671 in a volumeof 0.75 ml of substance carrier solution. The treatment groups (F and G)receive, orally by gavage, 1 mg/kg WX-671 in a volume of 0.75 ml ofsubstance carrier solution along with 50 mg/kg ABC294640 (group F) or 5mg/kg WX-671 in a volume of 0.75 ml of substance carrier solution alongwith 100 mg/kg ABC294640 (group G).

Growth of the inoculated tumors is determined in the dimensions lengthand width twice weekly, using a slide gauge. After the animals aresacrificed, the therapy end points, tumor weight, weights of theaxillary and intraperitoneal lymph nodes and also the number ofmacroscopic lung metastases are determined.

It is believed that treatment with the combination of WX-671 andABC294640 will achieve a considerable reduction in the size and,respectively, the weight of the tumors and in the number and,respectively, mass of metastases, in comparison with the treatmentgroups receiving either agent alone. In some embodiments, thecombination therapy result in a reduction of about 10% or more, about20% or more, about 30% or more, about 40% or more, about 50% or more,about 60% or more, about 70% or more, about 80% or more, about 90% ormore, about 95% or more, about 99% or more reduction in the size and,respectively, the weight of the tumors and in the number and,respectively, mass of metastases, in comparison with the treatmentgroups receiving either agent alone.

Prophetic Example—In Vivo Assay of the uPA Inhibitor Prodrug WX-671 andClarithromycin with Regard to Tumor Spreading, Tumor Growth andMetastasizing in Rats Breast Cancer Model

Fragments of 10-25 mm³ of the BN472 breast cancer (Kort et al., J. Natl.Cancer Inst 72, 709-713, 1984) from a donor animal are implantedunderneath the fatty body of a mammary gland of groups (n=15 per group)of female brown Norwegian rats aged 7-8 weeks. The treatments start 72 hafter tumor implantation and are repeated daily until the animals aresacrificed after 30 days. The control group (A) receives 0.75 ml of thesubstance-free substance carrier solution consisting of 5% ethanol, 5%D-mannitol and 5% Tween 20 in water orally by gavage. The treatmentgroups (B and C) receive, orally by gavage, either 1 mg/kg (group B) or5 mg/kg (group C) WX-671 in a volume of 0.75 ml of substance carriersolution. The treatment groups (D and E) receive, orally by gavage,either 10 mg/kg/day (group D) or 50 mg/kg/day (group E) CAM. Thetreatment groups (F and G) receive, orally by gavage, 1 mg/kg WX-671 ina volume of 0.75 ml of substance carrier solution along with 10mg/kg/day CAM (group F) or 5 mg/kg WX-671 in a volume of 0.75 ml ofsubstance carrier solution along with 50 mg/kg/day CAM (group G).

Growth of the inoculated tumors is determined in the dimensions lengthand width twice weekly, using a slide gauge. After the animals aresacrificed, the therapy end points, tumor weight, weights of theaxillary and intraperitoneal lymph nodes and also the number ofmacroscopic lung metastases are determined.

It is believed that treatment with the combination of WX-671 and CAMachieve a considerable reduction in the size and, respectively, theweight of the tumors and in the number and, respectively, mass ofmetastases, in comparison with the treatment groups receiving eitheragent alone.

In some embodiments, the combination therapy result in a reduction ofabout 10% or more, about 20% or more, about 30% or more, about 40% ormore, about 50% or more, about 60% or more, about 70% or more, about 80%or more, about 90% or more, about 95% or more, about 99% or morereduction in the size and, respectively, the weight of the tumors and inthe number and, respectively, mass of metastases, in comparison with thetreatment groups receiving either agent alone.

Prophetic Example—In Vivo Assay of the SK2 Inhibitor ABC294640 andClarithromycin with Regard to Tumor Spreading, Tumor Growth andMetastasizing in Rats Breast Cancer Model

Fragments of 10-25 mm³ of the BN472 breast cancer (Kort et al., J. Natl.Cancer Inst 72, 709-713, 1984) from a donor animal are implantedunderneath the fatty body of a mammary gland of groups (n=15 per group)of female brown Norwegian rats aged 7-8 weeks. The treatments start 72 hafter tumor implantation and are repeated daily until the animals aresacrificed after 30 days. The control group (A) receives 0.75 ml of thesubstance-free substance carrier solution consisting of 5% ethanol, 5%D-mannitol and 5% Tween 20 in water orally by gavage. The treatmentgroups (B and C) receive, orally by gavage, either 50 mg/kg (group B) or100 mg/kg (group C) ABC294640 in a volume of 0.75 ml of substancecarrier solution. The treatment groups (D and E) receive, orally bygavage, either 10 mg/kg/day (group D) or 50 mg/kg/day (group E) CAM. Thetreatment groups (F and G) receive, orally by gavage, 50 mg/kg ABC294640along with 10 mg/kg/day CAM (group F) or 100 mg/kg ABC294640 along with50 mg/kg/day CAM (group G).

Growth of the inoculated tumors is determined in the dimensions lengthand width twice weekly, using a slide gauge. After the animals aresacrificed, the therapy end points, tumor weight, weights of theaxillary and intraperitoneal lymph nodes and also the number ofmacroscopic lung metastases are determined.

It is believed that treatment with the combination of ABC294640 and CAMwill achieve a considerable reduction in the size and, respectively, theweight of the tumors and in the number and, respectively, mass ofmetastases, in comparison with the treatment groups receiving eitheragent alone.

In some embodiments, the combination therapy result in a reduction ofabout 10% or more, about 20% or more, about 30% or more, about 40% ormore, about 50% or more, about 60% or more, about 70% or more, about 80%or more, about 90% or more, about 95% or more, about 99% or morereduction in the size and, respectively, the weight of the tumors and inthe number and, respectively, mass of metastases, in comparison with thetreatment groups receiving either agent alone.

In Vivo Test of the Effectiveness of WX-671 in the Colon Carcinoma ModelCC531

The anti-tumor efficacy of WX-671 was demonstrated using thetransplantable rat colon carcinoma CC531. Six to seven week old femaleanimals (n=18 per group, body weight range 100-130 g received from day 3after tumor inoculation onwards 0.03, 0.3 or 3.0 mg/kg of WX-671.Control animals received the vehicle (5% ethanol, 5% Tween2o, 5%D-mannitol in water). Seven weeks after tumor implantation the animalswere killed and evaluated with respect to primary tumor weight andmetastatic endpoints.

The final median tumor weight in treatment groups versus vehicle groupwas unchanged in the group receiving WX-671 at 0.03 mg/kg, reducednon-significantly by 6% in the group receiving WX-671 at 0.3 mg/kg andsignificantly (p=0.015) reduced by 15% in the group treated with 3mg/kg. The difference between terminal tumor sizes in the 0.3 mg/kggroups and the 3.0 mg/kg group was not significant, however. Regardingmetastatic endpoints the median number of macroscopic lung foci wassignificantly reduced (P<0.0001) by 37%, 64% and 57% relative to controlin the treatment groups receiving 0.03, 0.3 and 3.0 mg/kg, respectively.The median intraperitoneal lymph node weights were reduced by 31%, 41%and 46% relative to control in the three treatment groups, the lattertwo reductions being statistically significant (P<0.001).

A highly significant reduction of the number of macroscopic lung fociwas apparent in all treatment groups with the lowest dose (0.03 mg/kg,reduction by 37%) being the least efficacious. At 0.3 mg/kg the effectwas maximum (reduction by 64%) and was not improved (reduction by 57%)in the group receiving WX-671 at the ten-fold dose i.e. 3.0 mg/kg. Asimilar pattern was apparent regarding the weights of intraperitoneallymph nodes. Median weight reductions were achieved by 31% at 0.03 mg/kg(non-significant) and 41% and 46% at the medium and high dose level,respectively.

In Vivo Test of the Effectiveness of WX-671 in the PancreaticAdenocarcinoma Model CA20948

The anti-tumor efficacy of WX-671 was assayed in a metastatic ratpancreatic tumor model, CA20948. Groups of eighteen rats were inoculatedwith tumor by intraperitoneal injection of a tumor cell suspension,prepared from a solid tumor harvested from a donor rat.

In this model the intraperitoneally grafted cells migrate to thepancreas to form a pancreatic tumor intimately associated with thepancreas. Within 3 weeks the tumor disseminates typically to the liverto form metastatic lesions which can be counted. Treatments at doselevels of 0.03, 0.3 and 3.0 mg/kg once daily were orally applied dailyfrom day 3 onwards. One group received vehicle as a control and onegroup received 0.3 mg/kg of WX-UK1 by intraperitoneal injection.

The table below lists the respective percentage reduction of mediantumor endpoints relative to control. All treatment schedules had ahighly significant effect on the final intraperitoneally grafted tumorplus pancreas mass and on the number of macroscopic liver foci comparedwith control. Reduction of liver metastasis seemed to be dose dependent.

To assess whether the treatments would have influence not only on liverfoci counts but also on the growth rate of metastatic lesions, therelative abundance of large metastases (>2 mm) in the various groups wasassessed. The percentage of large liver foci was determined by dividingthe number of large lesions by the number of total lesion detected onthe livers. Results are listed in the Table below. In the vehicle groupthe percentage of large metastases was 30.7% whereas in the treatmentgroups the percentage of large liver lesions was uniformly smaller. Thisindicates that the treatments with WX-671 (and WX-UK1) not only reducedthe number of liver foci but may have also had an inhibitory activity onthe growth rate of the metastatic lesions.

Percentage of the number of large (>2 mm) metastatic liver lesion of thetotal number of liver lesions in the various treatment groups. CA20948percentage large pancreatic tumor mets Vehicle control 30.7% WX-671 0.03mg/kg 12.4% WX-671 0.3 mg/kg 16.2% WX-671 3.0 mg/kg 20.4% WX-UK1 0.3mg/kg 13.4%The anti-tumor efficacy of intraperitoneal WX-UK1 at 0.3 mg/kg wassimilar as the efficacy of oral WX-671 at the same dose or higher.

Cytotoxicity Profile of ABC294640

To assess the biological efficacy of ABC294640 in intact cells,ABC294640 was evaluated for cytotoxicity using human cancer cell lines.These experiments followed methods that have been extensively used. Celllines tested included MCF-7 human breast adenocarcinoma cells andMCF-10A non-transformed human breast epithelial cells. The indicatedcell lines were treated with varying doses of ABC294640 for 48 h. Cellsurvival was then determined using the SRB binding assay (Skehan et al.,1990, J Natl Cancer Inst 82: 1107), and the concentration of ABC294640that inhibited proliferation by 50% (the IC₅₀) was calculated. In MCF-7human breast adenocarcinoma cells, the IC₅₀ was 17 μM (represents themean±sd for replicate trials). In MCF-10A non-transformed human breastepithelial cells, the IC₅₀ was 21 μM (represents the mean±sd forreplicate trials). ABC294640 is antiproliferative atsub-to-low-micromolar. The transformed MCF-7 cells were significantlymore sensitive than were the non-transformed MCF-10A cells. Thisindicates that ABC294640 will inhibit the growth of tumor cells withoutinducing toxicity to normal cells within the patient. Overall, the datademonstrated that ABC294640 is able to enter intact cells and preventtheir proliferation.

Survey of Anticancer Activity of ABC294640

The data provided above demonstrates the ability of ABC294640 to inhibitthe proliferation of human breast carcinoma cells. To examine the rangeof anticancer, the chemotherapeutic potency of ABC294640 towards a panelof varied human tumor cell lines representing several major tumor typeswere determined. The data are described below, and demonstrate thatABC294640 has anticancer activity against a wide variety of cancers.

Potencies of SK inhibitors toward human tumor cell lines. IC₅₀ (μM) CellLine Tissue Compound 62 1025LU melanoma 33.7 ± 2.7 A-498 kidney 12.2 ±6.0 Caco-2 colon 11.8 ± 5.6 DU145 prostate 21.9 ± 1.5 Hep-G2 liver  6.0± 2.6 HT-29 colon 48.1 ± 7.6 MCF-7 breast, ER+ 18.4 ± 7.4 MDA-MB-231breast, ER−  29.1 ± 11.1 Panc-1 pancreas 32.8 ± 0.1 SK-OV-3 ovary 10.5 ±2.6 T24 bladder 39.4 ± 7.4Sparsely plated cells were treated with an SK inhibitor for 48 hours,and cell viability was determined using sulforhodamine B staining andcompared to vehicle-(DMSO) treated cells.

-   -   Values are the mean sd for at least three separate experiments.

In Vivo Toxicity of ABC294640

ABC294640 was found to be soluble to at least 15 mg/ml (˜30-40 mM) inDMSO:PBS for intraperitoneal (IP) administration or PEG400 for oraldosing. Acute toxicity studies using IP dosing demonstrated no immediateor delayed toxicity in female Swiss-Webster mice treated with up to atleast 50 mg/kg of ABC294640. Repeated injections in the same mice everyother day over 15 days showed similar lack of toxicity. ABC294640 couldalso be administered orally to mice at doses up to at least 100 mg/kgwithout noticeable toxicity.

Antitumor Activity of ABC294640

The antitumor activity of ABC294640 was evaluated using a syngeneictumor model that uses the mouse JC mammary adenocarcinoma cell linegrowing subcutaneously in immunocompetent Balb/c mice (Lee et al., 2003,Oncol Res 14: 49). These cells express elevated levels of SK activityrelative to non-transformed cells, as well as the multidrug resistancephenotype due to P-glycoprotein activity.

Balb/c mice, 6-8 weeks old, were injected subcutaneously with 10⁶ JCcells suspended in phosphate-buffered saline. ABC294640 was dissolved inPEG400 and administered to mice every-other day at a dose of 100 mg/kg.Body weights and tumor volumes were monitored daily. Tumor growth inanimals treated with ABC294640 was significantly lower (>70% decreasedat day 16) than tumor growth in control animals. ABC294640 inhibitedtumor growth relative to controls by 69%. Dose-response studies withABC294640 demonstrated that the compound has antitumor activity whenorally administered at doses of 35 mg/kg or higher.

Prevention of the Formation of “Multi-Drug Resistance” (MDR) in Humanand Animal Tumor Cells to Treatment with Cytostatic Agents bySimultaneous Administration of BVDU

The human tumor cell strain K562-WT and the tumor cell strain F46-WT ofthe mouse (WT=wild type=sensitive to cytostatic treatment=noamplification of the MDR-gene) is treated over several weeks with stagedincrease in concentrations of adriamycin. During the treatment the cellsacquire a resistance to this treatment. With non-resistant cells, 20ng/ml adriamycin at a treatment time of 4 days has a severely toxiceffect—the cells after long term treatment with staged increase inconcentration become totally insensitive to 20 ng/ml adriamycin. Theformation of resistance is based on the amplification of the MDR gene.In parallel experiments with adriamycin with either 0.5 or 1 μg/ml BVDUgiven together (BVDU acts in human tumor cells only from about 10 μg/mlin a toxic manner, and in mouse cells from about 8 μg/ml, BVDU preventsthe formation of resistance to adriamycin. The tumor cells remainsensitive to the cytostatic treatment and die off. The effect of BVDU isso intense that the treatment must be interrupted by rest stages (growthwithout substances), so that the experiment extends over 6 to 8 weeks.

BVDU+adriamycin treatment leads to a considerably weaker amplificationof the MDR gene than adriamycin treatment alone. At the end of thetreatment, there remain only cells which have acquired at least acertain resistance to the adriamycin treatment. The cells which haveremained non-resistant as a result of the BVDU treatment have alreadypreviously died off.

As the formation of resistance to cytostatic treatment in human tumorsis likewise based on the amplification of the MDR gene, the combinationof BVDU with an optional cytostatic agent offers the possibility ofcarrying out therapy at low doses and over longer periods of time thanpreviously.

Prevention of the Formation of “Multi-Drug-Resistance” (MDR) in TumorCells to Cytostatic Treatment by Simultaneous Administration ofAnti-Recombinogenic BVDU

The tumor cell strain F4-6-WT of the mouse (WT=wild type=sensitive tocytostatic treatment=no amplification of the MDR gene) is treated overseveral weeks with staged increases in concentration of adriamycin.During the treatment the cells acquire a resistance to this treatment.Whereas 20 ng/ml of adriamycin at a treatment time of 4 days has anextremely toxic effect on non-resistant cells, the cells after a longterm treatment with staged increases in concentration become totallyinsensitive to 20 ng/ml adriamycin. The formation of resistance is basedon the amplification of the MDR gene. The levels of β-actin MRNA arelikewise analyzed as comparison. β-actin is used as an internal controlfor the RNA quantity.

In parallel experiments, adriamycin is administered with 1 μg/ml ofBVDU, and prevented the formation of resistance to adriamycin. The tumorcells remain sensitive to the cytostatic treatment and die off. Theeffect of BVDU is so intense that the treatment has to be interrupted byrest phases (growth without substances), so that the experiment extendsover 6 to 8 weeks.

BVDU Treatment Increases the Sensitivity of AH13r Sarcoma Cells toChemotherapy-Induced Apoptosis. This Effect is Maintained Even afterDiscontinuation of the Cytostatic in the so-Called Recovery Phase

AH13r cells were subjected to increasing doses of the cytostaticmitomycin C (MMC). BVDU, given alone, showed no toxic effect. MMC+BVDUtreatment led, after three treatment cycles, to reduction in the cellnumber in comparison to treatment with MMC alone. This inhibitory effectwas maintained even after discontinuation of the cytostatic in the nextcycle, in the so-called recovery phase. The cells without MMC and BVDUcontinued to grow without inhibition. However, those which continued toreceive BVDU were greatly inhibited in their growth. Correspondingresults were achieved with methotrexate (MTX), doxorubicin (DOX) andmitoxantrone (MXA). The indication that the reduction in cell number isbased on apoptosis, was detected by means of Hoechst 33258/propidiumiodide (Hopi) double colouration.

Prophetic Example: Screening Compounds of the Invention to DetermineEffects on Cell Cycle and Cell Viability

The aim of this study is to determine the effect of agents of thepresent invention on cell cycle and cell viability in human cancer celllines. Human cancer cell lines are treated with each agent individuallyat various concentrations for 48, 72 and 96 hours. Cell viability ismonitored using a technique known in the art. For example, cellviability can be assessed using the CellTiter-Blue® Cell Viability Assay(#G8081, Promega, Mannheim, Germany), which provides a homogeneous,fluorescence-based method for monitoring cell viability. The cell cyclecan be analysed using flow cytometry, and apoptotic cells can beidentified by terminal deoxynucleotidyl transferase-mediated dUTP nicklabelling (TUNEL) and by DAPI.

Prophetic Example: Screening Compounds of the Invention to DetermineEffects on Cytokine Production

In this experiment, the levels of a broad panel of cytokines, includingat least some of IL-6, IL-8, IL-10, IL-12, IL-17, IL-23, and TNFα, aremonitored in the human cancer cell line supernatants using commerciallyavailable ELISA kits. More particularly, it is ascertained whether anyof the human cancer cell lines show a downregulation in their ability toproduce cytokines after being incubated with agents of the presentinvention at various concentrations.

Novel strategies for the treatment of cancer patients based on acombination of drugs are disclosed herein.

A combination of a 5′ substituted nucleoside and at least one antibioticfor use in the treatment of cancer, wherein (a) the 5′ substitutednucleoside is administered to a patient in one or more doses toestablish a therapeutically effective plasma level for a period of atleast one week, (b) the antibiotic is administered to a patient in oneor more doses to establish a therapeutically effective plasma level fora period of at least one week, and (c) the periods of a) and b) overlap.In an embodiment, the 5′ substituted nucleoside is brivudine. In anembodiment, the at least one antibiotic is selected from one of abactericidal or macrolide antibiotic. In an embodiment, the bactericidalantibiotic is rifabutin. In an embodiment, the macrolide antibiotic isclarithromycin. In an embodiment, the composition further comprisesclofazimine. In an embodiment, the composition further comprises atleast one anticancer agent selected from the group consisting ofchemotherapeutical agents, cytotoxic agents, cytostatic agents,immunotoxic agents and radiotherapy.

A combination of a 5′ substituted nucleoside and clofazimine, wherein(a) the 5′ substituted nucleoside is administered to a patient in one ormore doses to establish a therapeutically effective plasma level for aperiod of at least one week, (b) the clofazimine is administered to apatient in one or more doses to establish a therapeutically effectiveplasma level for a period of at least one week, and (c) the periods ofa) and b) overlap. In an embodiment, the 5′ substituted nucleoside isbrivudine. In an embodiment, the at least one antibiotic is selectedfrom one of a bactericidal or macrolide antibiotic. In an embodiment,the bactericidal antibiotic is rifabutin. In an embodiment, themacrolide antibiotic is clarithromycin. In an embodiment, thecomposition further comprises clofazimine. In an embodiment, thecomposition further comprises at least one anticancer agent selectedfrom the group consisting of chemotherapeutical agents, cytotoxicagents, cytostatic agents, immunotoxic agents and radiotherapy.

A combination of a 5′ substituted nucleoside, clofazimine, and at leastone antibiotic for use in the treatment of cancer, wherein (a) the 5′substituted nucleoside is administered to a patient in one or more dosesto establish a therapeutically effective plasma level for a period of atleast one week, (b) the clofazimine is administered to a patient in oneor more doses to establish a therapeutically effective plasma level fora period of at least one week, (c) the antibiotic is administered to apatient in one or more doses to establish a therapeutically effectiveplasma level for a period of at least one week, and (d) the periods ofa), b) and c) overlap. In an embodiment, the 5′ substituted nucleosideis brivudine. In an embodiment, the at least one antibiotic is selectedfrom one of a bactericidal or macrolide antibiotic. In an embodiment,the bactericidal antibiotic is rifabutin. In an embodiment, themacrolide antibiotic is clarithromycin. In an embodiment, thecomposition further comprises clofazimine. In an embodiment, thecomposition further comprises at least one anticancer agent selectedfrom the group consisting of chemotherapeutical agents, cytotoxicagents, cytostatic agents, immunotoxic agents and radiotherapy.

A combination of a 5′ substituted nucleoside, a sphingosine kinaseinhibitor, and at least one antibiotic for use in the treatment ofcancer, wherein (a) the 5′ substituted nucleoside is administered to apatient in one or more doses to establish a therapeutically effectiveplasma level for a period of at least one week, (b) the sphingosinekinase inhibitor is administered to a patient in one or more doses toestablish a therapeutically effective plasma level for a period of atleast one week, (c) the antibiotic is administered to a patient in oneor more doses to establish a therapeutically effective plasma level fora period of at least one week, and (d) the periods of a), b) and c)overlap. In an embodiment, the 5′ substituted nucleoside is brivudine.In an embodiment, the sphingosine kinase inhibitor is ABC294640. In anembodiment, the at least one antibiotic is selected from one of abactericidal or macrolide antibiotic. In an embodiment, the bactericidalantibiotic is rifabutin. In an embodiment, the macrolide antibiotic isclarithromycin. In an embodiment, the composition further comprisesclofazimine. In an embodiment, the composition further comprises atleast one anticancer agent selected from the group consisting ofchemotherapeutical agents, cytotoxic agents, cytostatic agents,immunotoxic agents and radiotherapy.

A combination of a 5′ substituted nucleoside, a sphingosine kinaseinhibitor, a urokinase inhibitor, and at least one antibiotic for use inthe treatment of cancer, wherein (a) the 5′ substituted nucleoside isadministered to a patient in one or more doses to establish atherapeutically effective plasma level for a period of at least oneweek, (b) the sphingosine kinase inhibitor is administered to a patientin one or more doses to establish a therapeutically effective plasmalevel for a period of at least one week, (c) the urokinase inhibitor isadministered to a patient in one or more doses to establish atherapeutically effective plasma level for a period of at least oneweek, (d) the antibiotic is administered to a patient in one or moredoses to establish a therapeutically effective plasma level for a periodof at least one week, and (e) said periods of a), b), c) and d) overlap.In an embodiment, the 5′ substituted nucleoside is brivudine. In anembodiment, the sphingosine kinase inhibitor is ABC294640. In anembodiment, the urokinase inhibitor is upamostat. In an embodiment, theat least one antibiotic is selected from one of a bactericidal ormacrolide antibiotic. In an embodiment, the bactericidal antibiotic isrifabutin. In an embodiment, the macrolide antibiotic is clarithromycin.In an embodiment, the composition further comprises clofazimine. In anembodiment, the composition further comprises at least one anticanceragent selected from the group consisting of chemotherapeutical agents,cytotoxic agents, cytostatic agents, immunotoxic agents andradiotherapy.

A combination of a sphingosine kinase inhibitor and at least oneantibiotic for use in the treatment of cancer, wherein (a) thesphingosine kinase inhibitor is administered to a patient in one or moredoses to establish a therapeutically effective plasma level for a periodof at least one week, and (b) the antibiotic is administered to apatient in one or more doses to establish a therapeutically effectiveplasma level for a period of at least one week, and (c) said periods ofa) and b) overlap. In an embodiment, the sphingosine kinase inhibitor isABC294640. In an embodiment, the at least one antibiotic is selectedfrom one of a bactericidal or macrolide antibiotic. In an embodiment,the bactericidal antibiotic is rifabutin. In an embodiment, themacrolide antibiotic is clarithromycin. In an embodiment, thecomposition further comprises clofazimine. In an embodiment, thecomposition further comprises at least one anticancer agent selectedfrom the group consisting of chemotherapeutical agents, cytotoxicagents, cytostatic agents, immunotoxic agents and radiotherapy.

A combination of a urokinase inhibitor and at least one antibiotic foruse in the treatment of cancer, wherein (a) the sphingosine kinaseinhibitor is administered to a patient in one or more doses to establisha therapeutically effective plasma level for a period of at least oneweek, and (b) the antibiotic is administered to a patient in one or moredoses to establish a therapeutically effective plasma level for a periodof at least one week, and (c) said periods of a) and b) overlap. In anembodiment, the urokinase inhibitor is upamostat. In an embodiment, theat least one antibiotic is selected from one of a bactericidal ormacrolide antibiotic. In an embodiment, the bactericidal antibiotic isrifabutin. In an embodiment, the macrolide antibiotic is clarithromycin.In an embodiment, the composition further comprises clofazimine. In anembodiment, the composition further comprises at least one anticanceragent selected from the group consisting of chemotherapeutical agents,cytotoxic agents, cytostatic agents, immunotoxic agents andradiotherapy.

A combination of a sphingosine kinase inhibitor, clofazimine, and atleast one antibiotic for use in the treatment of cancer, wherein (a) thesphingosine kinase inhibitor is administered to a patient in one or moredoses to establish a therapeutically effective plasma level for a periodof at least one week, (b) the clofazimine is administered to a patientin one or more doses to establish a therapeutically effective plasmalevel for a period of at least one week, (c) the at least one antibioticis administered to a patient in one or more doses to establish atherapeutically effective plasma level for a period of at least oneweek, and (d) the periods of a), b) and c) overlap. In an embodiment,the sphingosine kinase inhibitor is ABC294640. In an embodiment, the atleast one antibiotic is selected from one of a bactericidal or macrolideantibiotic. In an embodiment, the bactericidal antibiotic is rifabutin.In an embodiment, the macrolide antibiotic is clarithromycin. In anembodiment, the composition further comprises clofazimine. In anembodiment, the composition further comprises at least one anticanceragent selected from the group consisting of chemotherapeutical agents,cytotoxic agents, cytostatic agents, immunotoxic agents andradiotherapy.

A combination of a sphingosine kinase inhibitor and clofazimine, wherein(a) the sphingosine kinase inhibitor is administered to a patient in oneor more doses to establish a therapeutically effective plasma level fora period of at least one week, (b) the clofazimine is administered to apatient in one or more doses to establish a therapeutically effectiveplasma level for a period of at least one week, and (c) the periods ofa) and b) overlap. In an embodiment, the sphingosine kinase inhibitor isABC294640. In an embodiment, the at least one antibiotic is selectedfrom one of a bactericidal or macrolide antibiotic. In an embodiment,the bactericidal antibiotic is rifabutin. In an embodiment, themacrolide antibiotic is clarithromycin. In an embodiment, thecomposition further comprises clofazimine. In an embodiment, thecomposition further comprises at least one anticancer agent selectedfrom the group consisting of chemotherapeutical agents, cytotoxicagents, cytostatic agents, immunotoxic agents and radiotherapy.

A combination of a sphingosine kinase inhibitor, a urokinase inhibitor,and at least one antibiotic for use in the treatment of cancer, wherein(a) the sphingosine kinase inhibitor is administered to a patient in oneor more doses to establish a therapeutically effective plasma level fora period of at least one week, (b) the urokinase inhibitor isadministered to a patient in one or more doses to establish atherapeutically effective plasma level for a period of at least oneweek, (c) the antibiotic is administered to a patient in one or moredoses to establish a therapeutically effective plasma level for a periodof at least one week, and (d) said periods of a), b) and c) overlap. Inan embodiment, the sphingosine kinase inhibitor is ABC294640. In anembodiment, the urokinase inhibitor is upamostat. In an embodiment, theat least one antibiotic is selected from one of a bactericidal ormacrolide antibiotic. In an embodiment, the bactericidal antibiotic isrifabutin. In an embodiment, the macrolide antibiotic is clarithromycin.In an embodiment, the composition further comprises clofazimine. In anembodiment, the composition further comprises at least one anticanceragent selected from the group consisting of chemotherapeutical agents,cytotoxic agents, cytostatic agents, immunotoxic agents andradiotherapy.

A combination of a urokinase inhibitor and clofazimine for use in thetreatment of cancer, wherein (a) the urokinase inhibitor is administeredto a patient in one or more doses to establish a therapeuticallyeffective plasma level for a period of at least one week, and (b) theclofazimine is administered to a patient in one or more doses toestablish a therapeutically effective plasma level for a period of atleast one week, and (c) said periods of a) and b) overlap. In anembodiment, the urokinase inhibitor is upamostat.

A combination of a urokinase inhibitor, at least one antibiotic, andclofazimine for use in the treatment of cancer, wherein (a) theurokinase inhibitor is administered to a patient in one or more doses toestablish a therapeutically effective plasma level for a period of atleast one week, (b) the at least one antibiotic is administered to apatient in one or more doses to establish a therapeutically effectiveplasma level for a period of at least one week, (c) the clofazimine isadministered to a patient in one or more doses to establish atherapeutically effective plasma level for a period of at least oneweek, and (d) said periods of a), b) and c) overlap. In an embodiment,the urokinase inhibitor is upamostat. In an embodiment, the at least oneantibiotic is selected from one of a bactericidal or macrolideantibiotic. In an embodiment, the bactericidal antibiotic is rifabutin.In an embodiment, the macrolide antibiotic is clarithromycin. In anembodiment, the composition further comprises clofazimine. In anembodiment, the composition further comprises at least one anticanceragent selected from the group consisting of chemotherapeutical agents,cytotoxic agents, cytostatic agents, immunotoxic agents andradiotherapy.

A combination of a urokinase inhibitor and at least one antibiotic foruse in the treatment of cancer, wherein (a) the sphingosine kinaseinhibitor is administered to a patient in one or more doses to establisha therapeutically effective plasma level for a period of at least oneweek, and (b) the antibiotic is administered to a patient in one or moredoses to establish a therapeutically effective plasma level for a periodof at least one week, and (c) said periods of a) and b) overlap. In anembodiment, the urokinase inhibitor is upamostat. In an embodiment, theat least one antibiotic is selected from one of a bactericidal ormacrolide antibiotic. In an embodiment, the bactericidal antibiotic isrifabutin. In an embodiment, the macrolide antibiotic is clarithromycin.In an embodiment, the composition further comprises clofazimine. In anembodiment, the composition further comprises at least one anticanceragent selected from the group consisting of chemotherapeutical agents,cytotoxic agents, cytostatic agents, immunotoxic agents andradiotherapy.

What is claimed is:
 1. A combination comprising: a first compound,wherein the first compound is 3-(4-chlorophenyl)-adamantane-1-carboxylicacid (pyridine-4-ylmethyl)-amide or a pharmaceutical acceptable saltthereof; and (ii) a second compound, wherein the second compound isN-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-phenylalanine-4-ethoxycarbonylpiperazide,a stereoisomer, a racemic mixture, a metabolite, a salt, crystal, or anycombination thereof.
 2. The combination of claim 1, wherein the secondcompound is present as a sulfate or a hydrogen sulfate salt.
 3. Thecombination of claim 1, wherein the second compound is selected from thegroup consisting of:N-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(L)phenylalanine-4ethoxycarbonylpiperazide,N-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(D)phenylalanine-4-ethoxycarbonylpiperazide,andN-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(D,L)phenylalanine-4-ethoxycarbonylpiperazide,or a physiologically compatible salt thereof.
 4. The combination ofclaim 1, wherein the second compound isN-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(L)phenylalanine-4-ethoxycarbonylpiperazidehydrogen sulfate.
 5. The combination of claim 1, wherein the secondcompound is a crystalline form ofN-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(L)phenylalanine-4-ethoxycarbonylpiperazideor a physiologically compatible salt thereof.
 6. The combination ofclaim 1, wherein the first compound and the second compound areformulated for oral administration to a subject.
 7. The combination ofclaim 1 further comprising a chemotherapeutic agent.
 8. The combinationof claim 1 further comprising a radiation therapy agent.
 9. Thecombination of claim 1 further comprising an immunomodulator.
 10. Thecombination of claim 1 further comprising an immune checkpointinhibitor.
 11. The combination of claim 1 further comprising a matrixmetalloproteinase inhibitor.
 12. A pharmaceutical composition comprising(i) a first pharmaceutical composition, wherein the first pharmaceuticalcomposition comprises a first compound, wherein the first compound is3-(4-chlorophenyl)-adamantane-1-carboxylic acid(pyridine-4-ylmethyl)-amide or a pharmaceutical acceptable salt thereof;and (ii) a second pharmaceutical composition, wherein the secondpharmaceutical composition comprises a second compound, wherein thesecond compound isN-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-phenylalanine-4-ethoxycarbonylpiperazide,a stereoisomer, a racemic mixture, a metabolite, a salt, crystal, or anycombination thereof.
 13. The pharmaceutical composition of claim 12,wherein the first pharmaceutical composition includes a pharmaceuticallyacceptable excipient and wherein the second pharmaceutical compositionincludes a pharmaceutically acceptable excipient.
 14. The pharmaceuticalcomposition of claim 12, wherein the second compound is present as asulfate or a hydrogen sulfate salt.
 15. The pharmaceutical compositionof claim 12, wherein the second compound is selected from the groupconsisting of:N-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(L)phenylalanine-4ethoxycarbonylpiperazide,N-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(D)phenylalanine-4-ethoxycarbonylpiperazide,andN-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(D,L)phenylalanine-4-ethoxycarbonylpiperazide,or a physiologically compatible salt thereof.
 16. The pharmaceuticalcomposition of claim 12, wherein the second compound isN-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(L)phenylalanine-4-ethoxycarbonylpiperazidehydrogen sulfate.
 17. The pharmaceutical composition of claim 12,wherein the second compound is a crystalline form ofN-α-(2,4,6-triisopropylphenylsulfonyl)-3-hydroxyamidino-(L)phenylalanine-4-ethoxycarbonylpiperazideor a physiologically compatible salt thereof.
 18. The pharmaceuticalcomposition of claim 12, further comprising a chemotherapeutic agent, aradiation therapy agent, an immunomodulator, an immune checkpointinhibitor, a matrix metalloproteinase inhibitor or combinations thereof.19. The pharmaceutical composition of claim 12, wherein thepharmaceutical composition is formulated for oral administration to asubject.